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UNITED STATES OF AMERICA. 



HYGIENE OF THE NURSERY 



STARR. 



Other Books by Dr. Starr, 



THE DIGESTIVE ORGANS IN CHILDHOOD. 

The Diseases of the Digestive Organs in Infancy and 
Childhood. With Chapters on the Investigation of Dis- 
ease and the Management of Children. Cloth, $2.50 

PHYSIOLOGICAL ACTION OF MEDICINES. 

Prepared for the use of Students of the Medical Depart- 
ment, University of Penna. By Louis Starr, m.d., J. B. 
Walker, m.d. and W. M. Powell, m.d. Third Edition. 
Enlarged. 321110. Cloth, .75 

DISEASES OF CHILDREN. The Student's Guide 
to the Diseases of Children. By J. F. Goodhart, m.d., 
F.R.C.P., Physician to Evelina Hospital for Children, Dem- 
onstrator of Morbid Anatomy at Guy's Hospital. Edited, 
with notes and additions, by Louis Starr, m.d., Clinical 
Professor of Diseases of Children in the University of 
Pennsylvania. Cloth, $3.00 ; Leather, $3.50 

PUBLISHED BY 

P. Blakiston, Son & Co., 

IOI2 Walnut Street, Philadelphia. 



HYGIENE 



OF 



THE NURSERY. 



BY 



t/ 



LOUIS STARR, M.D., 



CLINICAL PROFESSOR OF DISEASES OF CHILDREN IN THE HOSPITAL OF THE UNIVERSITY 

OF PENNSYLVANIA ; PHYSICIAN TO THE CHILDREN'S HOSPITAL, 

PHILADELPHIA, ETC., ETC. 

'0 



f 



3° 



WITH TWENTY-ONE ILLUSTRATIONS. 







PYRlGH/ 



:?- 



OCT 3 iaw 



PHILADELPHIA: 

P. BLAKISTON, SON & CO., 

No. 1012 Walnut Street. 
1888. 



wash ■ 






Copyright, 1888, by Louis Starr, m.d. 



Press of Wm. F. Fell & Co., 

1220-24 SANSOM ST., 

PHILADELPHIA. 



TO 



MY LITTLE PATIENTS 



SOME OF WHOM, 



IN THE RAPID PASSING OF TIME, MAY SOON ASSUME 
PARENTAL DUTIES, 



THIS VOLUME 



IS AFFECTIONATELY DEDICATED. 



PREFACE 



Having a firm belief in the proverb that " an ounce of 
prevention is worth a pound of cure," the author has 
endeavored, in the succeeding pages, to point out a series of 
hygienic rules which, if applied to the nursling, can hardly 
fail to maintain good health, give vigor to the frame and 
so lessen susceptibility to disease. 

He feels, too, that intelligent parents are ever ready to be 
instructed and willing to cooperate in the great work of 
preventing disease — the highest aim of scientific medicine. 

While every woman of ordinary brain-power can do 
much to keep her baby well, she should recognize that 
years of training and experience are necessary to acquire 
the ability to put the full value upon symptoms, and to 
handle the tools of medicine. Therefore, little or no ref- 
erence has been made to drugs or methods of medical 
treatment. 

The first chapter is written with the object of hinting to 

the mother when, by deviations from the features of health, 

she may expect the onset of disease and call in professional 

counsel. The last is offered, not as a complete guide to the 

vii 



Vlll PREFACE. 

practice of physic, but simply for the sake of giving infor- 
mation upon questions that often arise in the nursery. 

The child's doctor, in our day, regulates his patient's diet, 
clothing, bathing and exercise, and looks into the hygiene 
of the nursery before he orders medicines, and if the mother 
has sound ideas upon these subjects she is no mean assistant. 

The author's thanks are due to Dr. W. M. Powell for 

efficient aid in the preparation of the manuscript and index, 

and to Dr. Allen J. Smith for the illustrations. 

LOUIS STARR. 
1922 Spruce Street, Philadelphia. 

September, 1888. 



CONTENTS. 



CHAPTER I. page 

The Features of Health, 17 

CHAPTER II. 
The Nursery, 49 

CHAPTER III. 
The Nurse-Maid 63 

CHAPTER IV. 
Clothing, 67 

CHAPTER V. 
Exercise and Amusements, 82 

CHAPTER VI. 
Sleep, 91 

CHAPTER VII. 
Bathing, 96 

CHAPTER VIII. 
Food, . . 114 

CHAPTER IX. 
Dietary, ... 159 

CHAPTER X. 

Emergencies, 178 

ix 



HYGIENE OF THE NURSERY. 



CHAPTER I. 

THE FEATURES OF HEALTH. 

Every ill child presents certain well-defined alterations in 
the manner of performance of the various functions of his 
body. Thus, the pulse and respiration may be altered in 
character and frequency; the surface temperature maybe 
elevated ; the color and condition of the skin may be 
changed; the appetite maybe diminished; weight may be 
lost, and so on. These alterations from the normal state 
are termed symptoms. 

Healthy children, on the other hand, as uniformly show 
evidences of their well-being, which, for want of a better 
name, may be called the; features of health. Of these, every 
mother should have a full knowledge, so that by appre- 
ciating variations she may anticipate the complete develop- 
ment of disease, and early summon skilled aid, at the time 
when it is of most service. 

Early life must be divided into two periods, namely, 
infancy and childhood. Infancy is the time elapsing between 
birth and the complete eruption of the milk teeth, an event 
that transpires about the end of the second year of life. 
Childhood extends from this age to the development of 
puberty, or to the age of thirteen or fifteen years. It is 
important to remember these two divisions, as frequent 
reference will be made to them in the subsequent pages. 

With this brief preparation, the study of the features of 
health may be entered upon. 

17 



l8 HYGIENE OF THE NURSERY. 

i. The Face. — The face of a healthy, sleeping child 
wears an expression of absolute repose. The eyelids are 
completely closed, the lips very slightly parted, and, though 
a faint sound of rhythmical breathing may be heard, there 
is no visible movement of the nostrils. When awake and 
undisturbed, the healthy infant's face has a look of wonder- 
ing observation of whatever is going on about it. As age 
advances intelligence gradually supplants the wondering 
gaze, and no one can be unfamiliar with the bright, round, 
happy face of perfect childhood, so indicative of careless 
contentment, and so mobile in response to emotions. 

Examples of Variations in Disease. — Incomplete closure 
of the eyelids, rendering the whites of the eyes visible 
during sleep, is a symptom in all acute and chronic diseases 
of a severe type, it is also to be observed when rest is ren- 
dered unsound by pain, wherever seated. Twitching of the 
eyelids, oscillation of the eyeballs and squinting, herald the 
visit of convulsions. Widening of the orifices of the nose 
with movements of the nostrils to and fro, point to embar- 
rassed breathing from disease of the lungs or their pleural 
investment. Contraction of the brows indicates pain in the 
head ; sharpness of the nostrils, pain in the chest, and a 
drawn upper lip, pain in the abdomen. To make a general 
rule, it may be stated, that the upper third of the face 
is altered in expression in affections of the brain ; the middle 
third in diseases of the chest, and the lower third in diseases 
of the organs contained in the abdominal cavity. 

2. The Skin and General Appearance. — In the new- 
born infant the color of the skin varies from a deep to a 
light shade of red. After the first week this redness fades 
away, leaving the surface yellowish white. At times this 
yellow color is so marked that it might be mistaken for 
jaundice were it not that the whites of the eyes remain per- 



THE FEATURES OF HEALTH. 1 9 

fectly pearly, which is never the case in the disease men- 
tioned. After the second week all discoloration disappears 
and the skin assumes its typical appearance. 

With certain well-known natural variations in complexion 
the skin of a healthy child is beautifully white and trans- 
parent. The cheeks, palms of the Hands and soles of the feet 
have a delicate pink color, while the general surface is rosy 
in a warm atmosphere and marbled with faint blue spots 
or lines in a cold one. As age advances the coloring be- 
comes more pronounced, and until the completion of child- 
hood the complexion is much fresher than in adult life. 

Other characters of the healthy skin are, a velvety 
smoothness and softness, a scarcely perceptible moisture, 
and a great degree of elasticity. 

If an infant be stripped the large size of the head and 
trunk, and the relatively short arms and even shorter legs, 
will strike the observer at once. This disproportion, espe- 
cially noticeable in the head, is an actual one. For if in a 
child of one year, for example, the distance from the lower 
edge of the chin to the top of the head be measured, it will 
be found to be equal to one-fourth of the entire length of 
the body. The vertical length of the head, too, falls but 
little short of that of the trunk, and the latter in turn is 
nearly as long as the legs. 

Again, the abdomen is full and prominent, making the 
chest look, in comparison, rather contracted and narrow, 
and the navel is less deeply sunken than in adults. 

These features, which will be referred to more minutely 
in a later section, are most marked in young infants, and 
undergo gradual alterations as growth progresses and the 
child develops into the lithe, active youth or maiden. 

The shape of the head varies greatly between the round, 
bullet form and the elongated oval one. When it has been 



20 HYGIENE OF THE NURSERY. 

subjected to much pressure, instrumental or otherwise, 
during delivery, it is often so distorted as to shock the 
expectant mother. Little fear of permanent disfigure- 
ment need be entertained, however, as the deformed head 
usually assumes a natural shape in time. The same is true 
of less noticeable depressions, prominences and irregulari- 
ties. But it should be remembered that restoration to 
symmetry must be left entirely to nature, as any attempt 
to mould the skull by pressure rarely fails to injure the 
delicate brain beneath. 

The anterior fontanelle, or, as it is called by nurses, 
" the opening of the head," is readily seen and felt in 
infants under a year old. In the normal state it is level 
with, or very slightly depressed below, the surrounding 
bones of the skull, and may be observed to pulsate, or rise 
and fall, rhythmically. To the fingers it feels soft and 
yields readily to pressure. 

Examples of Variatioiis in Disease. — Lividity of the eye- 
lids and lips is a sign of imperfect oxidization of the blood, 
and points to disease of the heart or lungs. A decided 
yellow color of the skin and whites of the eyes is seen in 
jaundice ; an earthy tinge of the face, in long-standing 
disease of the bowels ; a waxy pallor in kidney disease, 
and paleness in any acute or chronic affection attended by 
exhaustion. 

Marked squareness of the head with projection of the 
forehead, a widely-open fontanelle, and a relatively small 
face indicates rickets. A large, globular head is character- 
istic of hydrocephalus or " water on the brain." Bulging 
of the fontanelle is also a symptom of hydrocephalus, 
while depression shows general debility and the need of food 
or stimulants. 

Great distention of the abdomen is usually due to an 



THE FEATURES OF HEALTH. 



21 



accumulation of gas in the intestines, and indicates disease 
of this portion of the digestive tract ; marked depression, 
on the other hand, is encountered in serious brain affec- 
tions, in cholera infantum, inflammation of the intestines and 
dysentery. 

3. Development. — To be robust the newly-born infant 
must have a certain average length and weight. The length 
varies between sixteen and twenty-two inches, and the 
weight between six and eight pounds. 

From the first day growth, or increase in length and 
weight, steadily progresses, according to certain definitely 
fixed rules. 

Length increases most rapidly during the first week of 
life ; afterward the progress is almost uniform up to the fifth 
month, and then it becomes less rapid, though still uniform, 
until the end of the twelfth month. 

These facts may be seen in the following table : — 



AGE. 


LENGTH. 


Birth. 


19.5 inches. 


1 month 


20.5 " 


2 " 


21. " 


3 " 


22. " 


4 " 


23. 


5 " 


23-5 " 


6 « 


24. 


7 " 


24-5 " 


8 « 


25. 


9 " 


255 " 


10 " 


26. " 


11 " 


26.5 " 


12 " 


27. " 



22 



HYGIENE OF THE NURSERY. 



During the second year the increase is from three to five 
inches ; in the third from two to three and a half inches ; in 
the fourth from two to three inches, and from this age up 
to the sixteenth year the average annual gain is from one 
and two- thirds to two inches. 

In the first three days of life there is always a loss of 
weight, but by the seventh day the babe should have 
regained weight and be as heavy as at birth. The period 
of most rapid gain in this respect is during the first five 
months of life. The maximum is attained during the 
second month, when the increase is from four to seven 
ounces each week. Throughout the next three months the 
increase amounts to about five ounces per week, and in 
the remaining months of the first year from two to five 
ounces. 

The subjoined table shows the average rate of gain : — 



AGE. 


WEIGHT. 


Birth. 


7 pounds. 


I month 


VA " 


2 " 


9 l A " 


3 " 


II " 


4 " 


\2% " 


5 " 


14 " 


6 " 


15 « 


7 " 


16 " 


8 " 


17 " 


9 " 


18 " 


IO " 


19 " 


ii " 


20 " 


12 « 


21 " 



THE FEATURES OF HEALTH. 23 

From the first to the tenth year there should be a yearly 
gain of at least four or five pounds, and after, to the six- 
teenth year, of about eight pounds in the same period. 

Parents frequently over-estimate the weight of their 
children by placing them upon the scales when completely 
dressed. To be accurate, the weight of the clothing must 
be subtracted. This may be estimated at about three pounds 
for a child of three to five years, four pounds for one of 
eight years, and eight pounds at fifteen years. 

Another reliable evidence of the proper progress of de- 
velopment is the increase in the girth of the chest. Taking 
an infant weighing seven pounds and measuring nineteen 
and a half inches at birth, this should be a little over thir- 
teen inches. By the fourth month it should be increased to 
fifteen inches ; by the sixth, to sixteen ; by the twelfth to 
about seventeen ; by the fifth year to twenty-one, and by the 
sixteenth year to thirty. 

As already mentioned, the proportions of the different 
members of the frame in infancy differ materially from 
those of adolescence. 

Primarily the head and secondarily the body are large 
when compared with the arms and legs, but in the progress 
of healthy development this disproportion is gradually 
lessened until the perfect human figure is attained. This 
developmental process, however, does not affect all parts of 
the body equally, as may be seen in the accompanying 
diagram.* (p. 24.) 

The description is so well put in the journal from which 
this figure is taken that I cannot do better than quote it 
word for word. 

" The six figures represent the average relative stature of 

*" Babyhood," Vol. IT, page 311. 



N 



24 



HYGIENE OF THE NURSERY. 



males of the ages of one, five, nine, thirteen, seventeen, and 
twenty-two years. It will be noticed that the figures all 
stand on a level plain. The tops of the heads are connected 
by a dotted line, and the height of each figure is divided 
into four equal parts, the points of division being connected 
with the corresponding ones in each figure. If the rate of 
growth were uniform the dotted lines connecting the heads 
would, of course, be straight if a child for every year were 
included in the rank. But in the* earlier years the growth 



Fig. i. 




iHI 



15 9 1 3 1 7 22 

DIAGRAM SHOWING RELATIVE STATURE FROM I TO 22 YEARS OF AGE. 



is much more rapid than it is later, and hence the line is a 
curve rising quite suddenly at the first, and becoming flatter 
toward the end of growth. It is to be understood that these 
are all averages — including, but not showing, the extremes 
of slowness and rapidity of growth as well as fitfulness of 
growth. The diagram also shows the different develop- 
ment of different parts of the person. The head, for in- 
stance, in the child of one year is nearly one-fourth of the 



THE FEATURES OF HEALTH. 25 

whole height ; that of the adult is about two-thirteenths, or, 
to use the phrase of artists, the little child is not much more 
than four heads high, while the adult of twenty-two is about 
six and one-half heads high ; and even this is a much 
larger head than the average adult has. Notice that the 
third dotted line, marking one-half of the total height, 
crosses the navel in the infant, while in the adult the half 
height mark is but little above the juncture of the legs and 
the body, which shows how much larger, proportionately, 
the body of an infant is than an adult's. If this same line 
be followed it will be noticed that it keeps well up in the 
abdomen until after the age of nine. Between that age and 
puberty the growth of the lower extremities is usually very 
rapid, and the well-knoWn " shooting up " of boys and girls 
takes place, the whole person growing, but the lower part 
in particular. Similar changes of location will be noticed 
by following the quarter-lines, but the changes are not so 
abrupt." 

It may be well t*o mention here that children will often 
remain, for a considerable time, almost stationary in height, 
and then have periods of very rapid growth. The latter is 
often to be observed in the ninth or tenth year, and again 
at the approach of puberty. Variations in weight-gain are 
also often to be observed ; these seem to hold a definite re- 
lation to the fluctuations in the rapidity of height-increase. 

Besides these points, which are the most reliable evi- 
dences of the proper progress of development, there are 
certain features that appeal more directly to the notice of 
parents, and on this account deserve consideration. The 
age at which a child sits erect, at which it creeps, walks or 
talks, are instances of the class of features referred to. 

The head can usually be held erect by the end of the 
third month and the body maintained in the sitting posture 



26 HYGIENE OF THE NURSERY. 

a month later. By the sixth month the infant can sit up 
with ease, accomplish many movements with the arms, hands 
and fingers, and enjoy playthings. At the eighth month 
he may be able to creep ; by the ninth or tenth to drag 
himself upon his feet with the assistance of his hands and 
arms and some artificial support; by the eleventh to walk 
with assistance; by the fourteenth to walk alone, and by the 
eighteenth to run. 

At eight months an infant will imitate sounds and 
articulate several syllables ; at ten can often speak one or 
two words, and after twelve months is able to join several 
words together. 

The anterior fontanelle should be completely closed at 
some period between the fifteenth and twentieth months. 

Tears begin to be secreted during the third or fourth 
month, and saliva between the fifth and sixth. 

After birth both hair and eyes often change color as age 
advances. When an alteration takes place in the eyes, it 
begins about the sixth or eighth week and may be to either 
a lighter or darker hue. Changes in the hair begin later, 
the tendency always being to darken, and the most marked 
alteration occurring between the seventh and fourteenth 
years. 

Examples of Variations in Disease. — If on being measured 
and weighed, a child be found to fall short of the normal 
standard for its age, and if, at the same time, there is a want 
of plumpness of body, roundness of limb, and firmness of 
flesh, the existence of some fault in diet or in the digestion 
and absorption of food must be inferred. 

A delay in walking may be due to general feebleness or 
to paralysis of the muscles of one or both legs, and a limp- 
ing gait with pain in the knee suggests hip-joint disease. 

Closure of the fontanelle is retarded by the disease 



THE FEATURES OF HEALTH. 2J 

called rickets, and also by hydrocephalus and constitutional 
syphilis. 

It is well to be cognizant of the fact that girls develop 
more rapidly than boys, and that the second and later chil- 
dren of the same family, by imitating their elders in the 
nursery, learn to talk and walk earlier than those who 
happen to be born first. 

4. Position and Gestures. — The complete repose de- 
picted on the countenance of a sleeping child when free 
from illness is shown also by the posture of the body. The 
head lies easy on the pillow, the trunk rests on the side, 
slightly inclined backward, the limbs assume various but 
always most graceful attitudes, and no movement is observ- 
able but the gentle rise and fall of the abdomen in respira- 
tion. In the waking state, the child, after early infancy, is 
rarely still. The movements of the arms, at first awkward, 
soon become full of purpose as he reaches to handle and 
examine various objects about him. The legs are idle 
longer, though these, too, soon begin to move about with 
method, feeling the ground, in preparation, as it were, for 
creeping and walking. 

Examples of Variations in Disease. — Restless sleep with a 
desire to be rocked, fondled or "walked" in the nurse's 
arms, are common symptoms of acute attacks of illness, 
especially when attended by pain. Children beyond the age 
of infancy toss about uneasily in bed or demand a change 
from the bed to the lap, under similar circumstances. 
Extreme and long-continued drowsiness and quietness, on 
the other hand, often precede the visit of such specific fevers 
as scarlatina or measles. 

Sleeping with the head thrown back and the mouth open 
indicates enlarged tonsils; a tendency to "sleep high," or 
with the head and shoulders elevated by the pillow accom- 



28 HYGIENE OF THE NURSERY. 

panies disease of the heart and lungs, and " sleeping cool," 
that is, resting only after the bed clothing has been kicked 
off, is an early symptom of rickets. 

Frequent carrying of the hand to the head, ear or mouth 
shows headache, earache, or the pain of a coming tooth, as 
the case may be, while constant rubbing of the nose is a 
feature of irritation of the bowels or stomach. 

Should the thumbs be drawn into the palms of the hands, 
and the fingers tightly clasped over them, or if the toes be 
strongly flexed or extended, a convulsion may be expected. 

5. The Voice. — Crying is the chief if not the only way 
that the young infant possesses of making known his dis- 
pleasure, discomfort or suffering, and affords almost the sole 
means of determining the characters of the voice at this 
early age. Again, even long after the powers of speech 
have been developed, the cry continues to be the main 
channel of complaint. 

One rarely hears a healthy child cry, unless a harsh word, 
a fall or a blow cause a passing storm of grief, anger or 
pain. Hence, frequent, peevish crying points to some dis- 
turbance of the healthy balance. 

The sound of the voice, whether in crying or speaking, 
should have a clear ring, without either muffling, hoarseness 
or nasal tone. Weeping should accompany crying, after the 
establishment of tear secretion. Cough, although not a 
normal vocal sound, is also worthy of attention. 

Examples of Variations in Disease. — Incessant, unappeas- 
able crying is usually due to earache or hunger; it frequently, 
too, is caused by the constant pricking of a badly-adjusted 
safety-pin or other mechanical irritant. 

If crying occur during an attack of coughing it is an indi- 
cation of some painful affection of the chest; if just before 
or after an evacuation of the bowels, of intestinal pain. 



THE FEATURES OF HEALTH. 20, 

When the cry has a nasal tone it should suggest swelling 
of the lining membrane of the nose, or other obstructing 
condition. Thickening and indistinctness occurs with throat 
affections. A loud, brazen cry is a precursor of spasmodic 
croup, and a faint, whispering cry of true or membranous 
croup. Hoarseness points to disease of the lining mem- 
brane of the larynx, either catarrhal or syphilitic in nature. 

Finally, a manifest unwillingness to cry can be seen in 
pneumonia and pleurisy, when the disease is severe enough 
to interfere materially with breathing. 

Tear-secretion having been established it is a bad omen 
if the secretion be arrested during the progress of an illness, 
but an equally good one if there be no suppression, or if 
there be a reestablishment after suppression. 

The cough, like the voice, may be brazen in spasmodic 
croup, hoarse in laryngeal catarrh, and suppressed in true 
croup. The qualities " tightness " and " looseness " are 
readily appreciated and give a good idea of the progress of 
lung affections, especially bronchitis, the former being an 
evidence of the beginning, the latter of the favorable termin- 
ation of an attack. 

Cough is always unproductive, that is, unattended by 
expectoration, in children under seven years of age. 

6. Mode of Drinking and Swallowing. — By watching 
an infant taking the breast or bottle, some information can 
be obtained of the condition of the mouth and throat, and 
of the respiratory organs. 

A healthy child drinks continuously without stopping to 
breathe, and swallows easily. 

Examples of Variations in Disease. — If there be any sore- 
ness of the mouth the nipple will be held only for a moment 
and then dropped with a cry of pain. When the throat is 
affected in infants, swallowing is performed with a gulp and 



3<D HYGIENE OF THE NURSERY. 

an expression of pain passes over the face, and no more 
efforts are made than required to satisfy the first cravings of 
hunger. Older children, under similar circumstances, drink 
little and refuse solid food. 

An infant suffering from the oppressed breathing of pneu- 
monia or severe bronchitis, seizes the nipple with avidity, 
swallows quickly several times and then pauses for breath. 
In older children the act of drinking, which should be con- 
tinuous, is interrupted in the same way. 

If the finger be put into the mouth of a healthy baby it 
will be vigorously sucked for some little time. Diminution 
of this act of suction during a severe illness is a sign of 
danger ; its reestablishment a good omen. In conditions 
of stupor it is noticeably absent. 

7. Appetite. — Hunger and appetite must not be regarded 
as synonymous terms. The former is the craving of all the 
tissues of the body for nutritive material, or food, and is ex- 
pressed by a sinking or craving sensation in the stomach. 
The latter, on the other hand, though it is certainly an 
attendant of hunger, is simply a sensation of the desire for 
something with a food-taste, having its seat in the mouth and. 
surrounding parts. Appetite having its post, as it were, 
at the entrance of the stomach, may be regarded as a gate- 
keeper to supervise everything presented for entrance and 
to reject all that may be injurious either to the stomach or 
the general economy. 

Like its analogue the gate-keeper, the trustworthiness of 
the appetite may be destroyed by over indulgence and bad 
habits. Under the last head come the constant administra- 
tion of too much or too little food, the use of over-rich food 
and irregularity in meal hours. 

A healthy appetite — that is one that leads a child to con- 
sume with enjoyment the food set before him — may be 



THE FEATURES OF HEALTH. 3 1 

encouraged by muscular and mental exercise ; by content- 
ment ; by regular habits as to the hours of eating ; by the 
use of plain food only, and by varying the food, in a greater 
or less degree, according to the age. If the quantity of food 
consumed at the regular meals does not come up to the 
parent's standard of sufficiency, nothing can be worse than 
too dainty feeding and an encouragement to eat between 
meals. 

There can be no question that a good appetite is a useful 
as well as a pleasant faculty for a child to possess, for there 
is no doubt that food eaten with relish is much better 
digested and therefore more serviceable in nutrition than 
that which is simply crowded into the stomach. 

Examples of Variations in Disease. — Loss of appetite is 
encountered in febrile attacks and in acute disorders of the 
stomach. Inordinate appetite, on the contrary, is usually 
met with when too sfrong food has been administered. Here 
the increased hunger is due to the fact that the food admin- 
istered, while it may be very rich in nutritive properties, is 
ill-adapted to the delicate digestive power of early life, and 
thus, by not being properly prepared for absorption, places 
the child in the anomalous position of starving in the midst 
of plenty. In more advanced children gluttony may depend 
upon gastric irritation, a condition which often leads older 
and presumably wiser heads to over-indulgence at table. 

8. Eructation. — Eructation or regurgitation is readily 
produced and of frequent occurrence in infancy, on account 
of the vertical position and cylindrical outline of the 
stomach at this period of life. 

Babies suckled at a freely-secreting breast, often eructate, 
though they may be in the best possible health. In these 
cases, the supply of food being large, the infant, as it lies at 
the breast, is apt to draw more than it needs and more than 



2,2 HYGIENE OF- THE NURSERY. 

it can digest, and the stomach, through a wise provision of 
nature, rids itself of the superabundance by the simple act 
of regurgitation. In this process, which in reality is an 
evidence of health, there is no violent muscular effort, as in 
retching or vomiting, nor any evidence of nausea, and the 
material ejected is the breast milk alone, either entirely 
unaltered or slightly curdled. 

In older children, expulsion of the contents of the stomach, 
or vomiting, may also occur after the stomach has been 
overladen. If the act be followed by relief from a feeling 
of general distress, headache and pain in the upper abdo- 
men, it is not to be regarded as a symptom of disease. 

Examples of Variations in Disease. — Vomiting, with its 
violent muscular effort and the attendance of the train of 
symptoms embraced under the term nausea — namely, pale- 
ness, languor, faintness and an increased secretion of saliva — 
occurs in many different conditions. It may indicate disease 
of the stomach, of the intestines, of the lungs or their pleural 
investment, and of the brain, or it may be an initial symptom 
of one of the eruptive fevers, scarlet fever or measles, for 
example, which condition, when existent, can only be 
determined by closely observing the special case. 

The character of the material ejected from the stomach 
is more definite. Thus, the expulsion of mucus is a symp- 
tom of gastric catarrh. The regurgitation of mouthfuls of 
curdled milk, partly digested food and liquid, so sour that 
it causes a grimace to pass over the face, is an indication of 
dyspepsia with fermentation and the formation of an irritant 
acid. The appearance of lumbricoid worms in the vomit, 
a not very infrequent occurrence, shows, without dispute, the 
existence of these parasites in the digestive canal. 

9. The Faecal Evacuations. — The daily number of 
evacuations of the bowels natural for a child varies greatly 



THE FEATURES OF HEALTH. 33 

with its age. For the first six weeks there should be three 
or four movements every twenty- four hours. After this time 
up to the end of the second year, two movements a day is 
the normal average. Subsequently, the frequency is the same 
as in adults — once per diem — though two or three move- 
ments in the same interval may occur, especially after over- 
feeding or after eating food difficult of digestion, and must 
be looked upon as conservative rather than as the evidence 
of ill-health. 

During the first period the passages have the consistence 
of thick soup, are yellowish-white or orange-yellow in color, 
with sometimes a tinge of green, have a faint faecal, slightly 
sour odor, and are acid in reaction. In the second, they 
are mushy or imperfectly formed, of uniform consistence 
throughout, brownish-yellow in color, and have a more 
faecal odor. The last two characters become more marked 
as additions are made to the diet. After the completion of 
the first dentition the motions have the same appearance as 
in adult life, they are formed, are brownish in color, and 
have a decided faecal odor. 

Examples of Variations in Disease. — Many alterations 
occur in disease. The frequency of the movements may be 
increased, constituting diarrhoea, or lessened, constituting 
constipation. In the former condition the consistency is 
diminished, in the latter increased. Instead of being uni- 
form throughout, the movement may be mixed, partly 
liquid, partly solid, indicating imperfect digestion, and curds 
of milk or pieces of undigested solid food may be mingled 
with the mass. Flaky, yellowish or yellowish-green evacua- 
tions, containing whitish, cheesy lumps, are also met with 
in cases of indigestion. Scanty, lumpy evacuations, dark 
brown or black in color, and mixed with mucus, are charac- 
teristic of intestinal catarrh. Doughy, grayish, or clay- 
3 



34 HYGIENE OF THE NURSERY. 

colored motions show an inactive liver. An intermixture 
of blood, altered blood clots, and shreds of mucous mem- 
brane, indicate ulceration of the intestinal lining, such as 
occurs in intestinal inflammation, typhoid fever, dysentery 
and tubercular disease. Watery, almost odorless passages 
occur in the latter stages of summer complaint ; most 
offensive, carrion-like motions, in both catarrhal and tuber- 
culous ulceration of the intestines, and sour-smelling evacua- 
tions in the diarrhoea of sucklings. The discovery of worms 
in the movements is the only certain evidence of the exist- 
ence of intestinal parasites. 

This mere outline of the changes that may take place will 
serve to show how much may be learned from the evacua- 
tions, and the importance of preserving them for the physi- 
cian's inspection. 

10. The Urine. — It is impossible to make a definite 
statement as to the number of times the urine is voided by 
a healthy infant in each twenty-four hours. In any given 
case the frequency will differ very much from day to day, 
depending upon the temperature of the surrounding air and 
the amount of moisture that it contains. Sometimes it will 
be necessary to change the napkin every hour during the 
day and three or four times at night. Again, it may remain 
dry for six, eight, or even ten hours. Neither condition 
indicates disease. If, however, the urine is not passed for 
twelve hours, a careful examination should be made. 

Between these two extremes there is a wide range of 
variation. 

As the child grows older the frequency diminishes, and 
at the age of three years the number of voidings will be 
reduced to six or eight during the waking hours, and per- 
haps one at night. When the desire does arise during sleep, 
the child, if in a normal state, wakes up and demands the 



THE FEATURES OF HEALTH. 35 

chamber, and never passes urine unconsciously. Wetting 
the bed, therefore, or the involuntary passage of the urine 
during sleep, is indicative of an abnormal condition and 
requires investigation. From a few observations, I am led 
to believe that the quantity of urine voided by healthy 
children from the fourth to the seventh years is not nearly 
so large as supposed; eighteen to twenty ounces being 
the average in several cases in which I have lately made 
measurements. 

The urine of an infant, while it wets, should not stain the 
napkin. 

Examples of Variations in Disease. — In certain cases of 
bad digestion the urine becomes very concentrated and 
high-colored, and gives a light yellow tinge to the napkin. 
When the stain is decidedly yellow, jaundice is indicated, 
and other symptoms of this condition should be looked for. 

In older children a high-colored urine, and one which 
deposits a whitish or purplish sediment on standing, is 
symptomatic of acute digestive disorder, either catarrhal in 
its nature, or secondary to some acute febrile affection. A 
smoky, blackish hue, looking as if there had been an admix- 
ture of soot, is characteristic of acute scarlatinal nephritis; 
in this state, too, there is a great diminution in the amount 
passed. 

Painful urination points to inflammation of the urethra, a 
narrow orifice, a highly acid condition of the excretion, or 
stone in the bladder. 

ii. The Respiration. — In adults there are two well- 
marked types of respiration, viz., the abdominal and the 
superior costal. The abdominal — met with in perfection in 
adult males — is the type in which the movements of inspira- 
tion and expiration are performed by the muscles of the 
abdomen and lower third of the chest. In superior costal 



36 HYGIENE OF THE NURSERY. 

respiration, on the other hand, the movements are most 
marked in the upper third of the chest; this form is best 
developed in healthy adult females. 

In children the respiration is chiefly abdominal in type, 
irrespective of sex, and it is not until just before the age of 
puberty that the movements in the female change, becoming 
superior costal. Consequently, in estimating the number of 
movements per minute it is best to place the fingers lightly 
on the upper abdomen. The count should always be made 
by the watch, the most convenient time for the observation 
being while the child sleeps. 

Soon after birth the number of movements per minute is 
44, between the ages of two months and two years 35, 
and between two and twelve years, 23. During sleep the 
frequency is reduced about twenty per cent. 

Children under two years, while awake, breathe unevenly 
and irregularly ; there are frequent pauses followed by 
hurry and precipitation, and some of the movements are 
shallow, others deep. In sleep there is greater regularity. 
After the second year the movements become steady and 
even, like those of adults. All children, however, but par- 
ticularly the very young, are subject to a great increase in 
the rapidity of respiration under the excitement of muscular 
movement and mental emotion. 

Perfectly healthy children breathe through the nose, and 
so softly that it is necessary to place the ear close to the 
face to hear the breezy sound of the ingoing and outgoing 
air. 

Examples of Variations in Disease. — Accelerated breathing 
occurs during the course of diseases attended by severe 
fever. Acute affections of the lungs are especially charac- 
terized by this alteration, and the more the breathing area 
is lessened the greater is the increase. Thus, in pneumonia, 



THE FEATURES OF HEALTH. 37 

60, 80 or 100 movements a minute are not at all unusual. 
To speak broadly, rapid breathing may be caused by an 
elevation in the body temperature, by an interference with 
the blood aeration and by thoracic or abdominal pain. 

Diminished frequency — the movements being reduced to 
16, 12, or even 8 in the minute — is encountered in certain 
brain affections ; namely, in chronic hydrocephalus, and the 
later stages of tubercular meningitis. In such cases the 
rhythm may be greatly altered — a tidal form being assumed, 
in which the breathing ebbs and flows, beginning with 
an act which is scarcely perceptible or audible, gradually 
growing deeper until a full, noisy respiration is made, 
and then slowly subsiding into a period of absolute quiet, 
variable in its duration. This is termed Cheyne-Stokes' 
respiration. 

A dry, hissing sound, or a moist sound of snuffling indi- 
cates partial obstruction of the nasal passages, oral respira- 
tion shows their complete occlusion. 

Yawning, one of the modifications of the respiratory act, 
if it recur frequently, denotes great failure of the vital 
powers and is an unfavorable prognostic element. 

12. The Pulse. — To obtain any reliable data from the 
pulse it must be felt during perfect quiet. During sleep is 
the best time, but if the child cannot be caught in this con- 
dition, advantage may be taken of its placidity while feed- 
ing or amused by a toy. With very young infants it is 
sometimes impossible to feel the beat of the artery at the 
wrist, and it is necessary to ascertain the frequency of the 
pulse by listening to the heart. After the second month 
feeling the pulse at the wrist in the ordinary way is not 
difficult. 

The child's pulse differs from the adult's by being much 
more frequent, more irregular, and more irritable. 



38 HYGIENE OF THE NURSERY. 



The frequency, or the number of beats per minute, varies 
ith the age. The following is the average rate : — 



From birth, to the 2d month . 
From the 2d to the 6th month. 



6th < 


' 1 2th " 


1st < 


3d year 


3d « 


5th " 


5th " 


10th " 


10th ' 


1 2th " 



160 


to 


130 


130 


to 


120 


120 


to 


no 


no 


to 


IOO 


IOO 


to 


qo 


90 


to 


80 


80 to 


70 



These figures represent the pulse in a waking but passive 
state. During sleep the frequency is less. Thus, between 
the second and ninth years, there are about sixteen beats 
less per minute while asleep than when awake ; between 
the ninth and twelfth years, eight less ; and between the 
twelfth and fifteenth years, only two less. Below the age 
of two years the disparity is even greater. 

The irregularity of the pulse in childhood is confined to 
an alteration of the rhythm. It is most marked in infants 
and is greatest during sleep, when the pulse is slowest. 

The feature of irritability, that is, the facility with which 
its frequency is increased by muscular activity and mental 
excitement, is greater in proportion to the youth of the 
child. A rise of 20, 30, or even 40 beats a minute is not 
uncommon in early infancy, under the excitement of the 
slightest effort or disturbance. 

Examples of Variations in Disease. — On account of the 
wide variations in health, little meaning need be attached to 
alterations of the rhythm and frequency while unassociated 
with other abnormal features. When so associated they 
become important in determining the existence of disease. 

Increased frequency is a constant attendant of the febrile 
state. The extent of the increase corresponds with the 
degree of elevation of temperature, though the pulse curve 
always runs higher than the temperature curve. As a rule, 



THE FEATURES OF HEALTH. 7)9 

the more frequent the pulse the higher the fever. In esti- 
mating the risk of the increase, however, the law of the 
fever in question must be taken into consideration. For 
example, in scarlatina a pulse of 160 is usual and not indica- 
tive of special gravity. In measles, the same degree of ac- 
celeration would be abnormal and show great danger. 

Jaundice and inflammation of the kidneys are accom- 
panied by a diminution of the rate. 

Irregularity is met with in diseases of the brain and heart, 
and sometimes in nervous and blood-impoverished children. 

13. The Temperature. — By placing the hand upon the 
surface of the body we can readily detect marked variations 
in the temperature; thus the nose and extremities feel cold 
in diseases associated with depression of the vital forces, and 
the palms of the hands and back of the head feel hot in those 
attended by fever. 

But the only possible means of detecting slight variations 
or of obtaining reliable information concerning normal or 
abnormal body-heat is by the employment of an accurate 
thermometer. Clinical thermometers, as these instruments 
are called, are made entirely of glass, and are usually fur- 
nished in one or two shapes. These may be seen in 
Figs. 2 and 3, p. 40. 

Both of these instruments are graduated according to the 
Fahrenheit scale and provided with a self-registering index, 
which is simply a short column of mercury separated from 
that in the bulb of the thermometer. 

Temperature is usually taken in the rectum of the infant 
or young child, in the arm-pit of one old enough to under- 
stand the importance of keeping the arm in the proper po- 
sition, and in the mouth of a child still older. In the first 
locality a straight thermometer is the best to use, in the last 
two a curved instrument will be found more convenient. 



40 



HYGIENE OF THE NURSERY. 



Supposing the rectum be chosen as the place of observa- 
tion, it is first necessary to be sure that this portion of the 
gut is free from faeces. The upper end of the stem of the 



Fig. 3 



Bulb with 
Mercury. 



Wa 



1. 5 normal mark. 

idex, read from top, 
stands now at o8°. 




Us 



>.5° normal mark. 



Index, read from top, 
stands now at 98.5 . 



CURVED THER- 
MOMETER. 



w 



STRAIGHT THERMOMETER. 



thermometer is then held between the thumb and finger, 
and the index, by a few vigorous shaking movements, is 



THE FEATURES OF HEALTH. 4 1 

forced down so far that its upper extremity will be well 
below the normal mark, to 95 ° for instance; next, the bulb 
is covered with sweet oil or vaseline and gently inserted 
through the anus into the rectum for a sufficient distance to 
conceal completely the mercury. Here it is allowed to 
remain for five minutes by the watch, and on being removed 
the degree of temperature is read from the top of the index. 
The position of the patient in the meanwhile is upon the 
back, on the nurse's lap, with the legs elevated and con- 
trolled by her left hand, the right hand being used in steady- 
ing the thermometer. 

If the arm-pit be selected, the child is placed on his back, 
and this region dried of all moisture ; the index is next 
shaken down and the bulb inserted well into the cavity ; the 
arm must then be laid across the chest, the hand placed on 
the opposite shoulder and held in this position for five 
minutes. 

When taking the temperature in the mouth it is well to 
direct the child to lie down on his back and instruct him not' 
to bite upon the delicate glass. Then, having seen that the 
instrument is thoroughly clean and that the top of the index 
is below the normal point, the bulb must be inserted, cross- 
wise, beneath the tongue, the teeth lightly closed so as to 
hold it in position, and the lips closely shut about its stem. 
For the three minutes necessary to complete the observa- 
tion, breathing must be performed entirely through the 
nose. 

One more fact is important, namely, that a simultaneous 
observation in the three positions mentioned will not fur- 
nish identical results ; the rectal temperature being, nor- 
mally, from i° to 2° higher, and the oral at least i° higher, 
than that of the arm-pit in the same individual. 

When properly used the thermometer is of great value 



42 HYGIENE OF THE NURSERY. 

in the nursery; at the same time, under opposite conditions, 
it may be the source of much unnecessary alarm to over- 
anxious parents. To prevent the latter misfortune., all who 
intend to use the instrument should be familiar with the 
healthy range of temperature and the more characteristic 
variations in disease. 

During the first week of healthy life the temperature 
fluctuates considerably. After this the puerile norme — 
98.5° to 99 F. — is established, but until the fourth or fifth 
month it is greatly influenced by physiological causes of 
variation, the fluctuations ranging between .9° and 3.6 . By 
the fifth month regular morning and evening oscillations 
begin to be noticeable, and certain definite laws are followed. 
Thus there is a fall in the evening of i° or 2°. The great- 
est fall occurs between 7 and 9 p.m., and the minimum is 
reached at, or before, 2 a.m. After 2 a.m. there is a gradual 
rise, the maximum being reached between 8 and 10 a.m. 
Throughout the day the oscillation is trifling. These varia- 
tions are independent of eating and sleeping. 

It may be taken for granted, therefore, that a temperature 
between 98 and 99 in the morning and 97. 5 and 98.5 ° 
in the evening is the range to be expected in a healthy 
child beyond the age of five months. 

Examples of Variations in Disease. — In disease there may 
be either a rise above or a fall below the normal standard. 

Fever is always associated with an elevation. Rapid and 
transient rises attend slight catarrhs and passing indiges- 
tions. Prolonged rises indicate inflammatory and essential 
fevers, for example, typhoid, scarlet fever and measles. 

The degree of elevation marks the type of the fever. 
This is moderate when the mercury stands at 102 , severe 
at 104 or 105 °, and very grave above 107 . The duration 
of the elevation and the peculiar range of the oscillations 



THE FEATURES OF HEALTH. 43 

(for there are oscillations in disease as well as in health) 
determine the nature of the fever. The febrile oscillations 
differ from the healthy, in that the lowest marking is noticed 
in the morning, the highest in the evening. 

Variations in the typical range of any given fever are 
important prognostic omens — a sudden fall of the tempera- 
ture, together with improvement in the general symptoms, 
indicates the beginning of convalescence — a similar fall, 
with an increase of the general symptoms, is a precursor of 
death. When the morning temperature is equal to that of 
the preceding evening, there is great danger ; if higher, 
greater danger still. Marked remission in continued fevers 
is generally a forerunner of convalescence. 

Abnormal depression of temperature is occasioned by 
hemorrhage and by the loss of fluids in cholera infantum or 
entero-colitis. It is also met with in anaemia, in wasting 
from insufficient nourishment, in diseases of the heart and 
lungs attended by imperfect oxidation of the blood, and it 
constantly attends collapse and the death agony. A tem- 
perature of 97 is dangerous in children, and for every 
degree of reduction below this point the risk for life is more 
than proportionately increased. 

14. The Mouth and Throat. — In infants, gentle press- 
ure of the fingers upon the chin is sufficient to cause wide 
opening of the mouth. An older child will frequently open 
the mouth when requested, but if he refuse, the finger, the 
handle of a spoon, or some other smooth, flat instrument, 
may be inserted in the mouth and downward pressure made 
upon the tongue, when the jaws will be widely separated. 
In some cases, when the child is old enough to do as he is 
bid, the fauces can be seen by directing the mouth to be 
opened wide and the tongue to be alternately protruded and 
retracted, or a prolonged sound of "Ah" to be made. 



44 HYGIENE OF THE NURSERY. 

With the refractory, and always with infants, the tongue has 
to be held down by a spoon-handle or tongue-depressor. 
If there be resistance, the patient must be taken on the lap 
of the nurse, who holds his back against her breast, directs 
his face toward a bright light, and controls the movements 
of his hands and feet. 

The healthy oral mucous membrane has a deep pink 
color, and is smooth, moist and warm to the touch. The 
color is deeper on the lips and cheeks, lighter on the gums. 
The latter, up to the sixth month, as a rule, have a moder- 
ately sharp edge. Subsequently, the edge begins to broaden 
and soften, and the color of the investing mucous membrane 
deepens to a vivid red, and becomes hot, as the teeth begin 
to force their way through. 

The tongue should be freely movable. It is pink in color, 
and the dorsum or upper surface, marked in the centre by a 
slight longitudinal depression, has a velvety appearance, and 
is soft, moist and warm to the finger. The velvety nap is 
due to the numberless hair-like processes of the filiform 
papillae. There are also scattered over the surface, but most 
closely at the tip, a number of eminences, the size of a small 
pin's head, circular in outline, and deeper pink than the 
general surface — the fungiform papillae While far back, 
defining the papillary layer, are the circumvallate papillae, 
numbering about twelve, and arranged in a V-shaped row. 
These have the form of an inverted cone, surrounded by an 
annular elevation. 

The hard palate, or roof of the mouth, is roughened 
anteriorly by transverse ridges. The soft palate — its con- 
tinuation — is smooth, and its mucous membrane is paler 
than that of the rest of the mouth. The fauces, or walls of 
the throat, on the contrary, are redder. In the triangular 
recess between the half arches of the palate the tonsils can 






THE FEATURES OF HEALTH. 45 

always be seen. They should be about the size and shape 
of almond kernels, and they present a number of circular 
openings, the orifices of pouches, into which the follicles 
open. The uvula — or, in popular language, the palate — is 
short and tongue-shaped. The posterior wall of the throat 
should be red, smooth and moist. 

Examples of Variations- in Disease. — Fever makes the 
mouth hot and dry, and causes the tongue to be frosted or 
coated. Affections of the gastro-intestinal tract are usually 
attended by coating of the tongue. Inflammation of the 
mouth itself reddens the lining membrane, makes it hot and 
tender to the touch, increases its moisture, alters the surface 
of the tongue and leads to the formation of aphthae, to 
ulceration, and even to gangrene. 

15. Dentition. — The eiuption of the twenty milk teeth 
may, like other physiological processes, be unattended by 
noticeable symptoms, but in many instances it is accom- 
plished with difficulty, giving rise to disturbances which, on 
the one hand, may be so trifling as simply to annoy the 
infant, or, on the other, so serious as to endanger life. 

Normally, the teeth are cut in groups, each effort being 
succeeded by a pause or period of rest. The diagram and 
table on page 46 show the grouping, the date of eruption 
and the duration of the pauses. The numbers, 1 to 5, indi- 
cating the groups to which the individual teeth belong and 
their order of appearance, and the letters a and b the pre- 
cedence of eruption in the different groups. 

The pauses are, to say the least, most helpful, giving the 
infant's system an opportunity to rest after each effort, to 
recover from any coincident illness, and to prepare for the 
next strain. 

Even under normal conditions the edges of the gums lose 
their sharpness and become swollen, rounded and reddened 



4 6 



HYGIENE OF THE NURSERY. 



as the teeth approach the surface. At the same time the 
saliva is increased in quantity, and the mouth is unnaturally 
warm and the seat of abnormal sensations, evidenced by the 
tendency to bite upon any object that comes to hand; in 
other words, there is a condition of mild catarrhal stomatitis. 
The consequent discomfort, though, is not sufficient to inter- 
fere with the child's appetite, good humor or sleep, and 



Fig. 4. 




DIAGRAM SHOWING ERUPTION OF MILK TEETH. 

i i, Between the 4th and 7th months. Pause of 3 to 9 weeks. 2222, Between the 8th and 
10 months. Pause of 6 to 12 weeks. 3 3 3 3 3 3, Between the 12th and 15th months. 
Pause until the 18th month. 4 4 4 4, Between the 18th and 24 months. Pause of 2 to 3 
months. 5555, Between the 20th and 30th months. 



when, after a few days, the margin of the tooth is free, all 
the local symptoms vanish. 

Examples of Variations. — Abnormal dentition is manifested 
either by departures from the laws of development already 
stated, or by actual difficulty in the process of cutting. 

The standard rules for the eruption of the teeth may be 
departed from in three ways : — 



THE FEATURES OF HEALTH. 47 

1. The appearance of the teeth maybe premature. Chil- 
dren may be born with one or more of their teeth already 
cut ; these are usually imperfect, and soon fall out, to be 
replaced, at the proper age, by well-formed milk teeth. 
Sometimes, however, they remain permanently, as in a case 
that came under my own observation. Natal teeth are 
always incisors. Instances of the lower central incisors 
being cut in the third month are not uncommon. Girls are 
more apt than boys to cut their teeth early, and, as an early 
dentition is likely to be an easy one, the occurrence is to be 
looked upon as fortunate. 

2. Dentition may be delayed. This deviation is more 
frequently seen and of more consequence than the first. 
Bottle-fed babies, as a class, are more tardy in cutting their 
teeth than those reared at the breast. With such, though 
healthy in every respect, a delay of one or two months is a 
common and not at all a serious event. On the contrary, 
whatever the method of feeding, if no teeth have appeared 
by the end of a year, it may be assumed that the child's 
general nutrition is faulty, or that rachitis is present. Delay 
does not necessarily imply difficulty in cutting the teeth, 
though the two conditions are often associated. 

3. The teeth may appear out of their regular order. 
Bottle-fed infants are most likely to show this irregularity, 
which is of some importance as an indication of general 
feebleness. In other instances, however, it is merejy a 
family peculiarity, and, as such, bears no special significance. 

Difficult dentition gives rise to two classes of affections, 
viz., local, and sympathetic or reflex. 

The third and fourth groups of teeth are most prone to 
make trouble, and when the child is born at such a time of 
the year as to bring the eruption of these during the hot 
months, illness of some sort may be anticipated. This is 



48 HYGIENE OF THE NURSERY. 

often dangerous and sometimes fatal, hence the popular 
dread of the " second summer." 

The order of eruption of the permanent teeth is as 
follows : — 

The two central incisors of lower jaw, from the 6th to 8th year. 
" " " " upper " " 7th to 8th 

" four lateral " . . . . « 8th to 9th 
" " first bicuspids, . . . . " 9th to loth 

" " canines, " 10th to nth 

" " second bicuspids, . . . " 12th to 13th 

These replace the temporary teeth ; those which are de- 
veloped de novo appear thus : — 

The four first molars, from the 6th to 7th year. 
" " second molars', from the 12th to 13th year. 
" " third molars, from the 17th to 21st year. 

There are, therefore, twelve more permanent teeth, making 
thirty-two in all — sixteen in each jaw. 

Second dentition is a common cause of ill health in late 
childhood. The disorders produced .by this process, how- 
ever, are not so well defined nor so dangerous as those of 
primary dentition, and, in consequence, the relation of cause 
and effect is often overlooked. 

It is probable that the first and seventh sets are the most 
apt to give rise to both local and constitutional disturbances. 



THE NURSERY. 49 



CHAPTER II. 

THE NURSERY. 

Every well-regulated house in which there are children 
should be provided with two nurseries, one for occupation 
by day, the other by night. 

Before entering further into the subject, however, atten- 
tion must be directed to the fact that the American city -bred 
child, belonging to the class in which it is possible to pro- 
vide separate rooms for nurseries, is to a greater or less 
degree a migratory creature. For when the first warm days 
of May or early June make the parents bask at open win- 
dows, the child is hurried off to a suburban hotel or farm- 
house or to the sea-coast. Again, so soon as the cold even- 
ings of late September suggest the comfort of an open fire, 
equal energy is exhibited to get him back to cosy winter 
quarters. In summer, most of the waking hours are spent 
in the open air, in winter, the greater proportion indoors, 
hence the day nursery must be regarded as a winter resort, 
and as such must possess qualities that would render it 
uninhabitable by the child in hot weather. The night nur- 
sery should have, though to a much less degree, the same 
qualities. In other words, to put the whole subject in a nut- 
shell, the nurseries for winter use should be warm and freely 
exposed to the sun; for summer use, cool and rather shaded, 
though always perfectly dry. 

Since the child spends so much time in the open air dur- 
ing warm weather, the nurseries will be discussed in this 
chapter purely from their winter standpoint, and will be 
described under the following heads: — 



50 HYGIENE OF THE NURSERY. 

Situation. — Any room in the house will not do for a day 
nursery. Rather, on the contrary, must the best room be 
selected. It should have a southwest exposure, and be, if 
possible, so situated in the building as to allow of at least 
two broad windows,* one in the southern end and one in 
the western side. Into such a room the sun plays with full 
force from a few hours after rising until nearly the time of 
setting. The third floor of the house is a better elevation 
for the nursery, especially if there be an attic above, than 
either of the lower floors, partly because such rooms are 
remote from the ordinary domestic disturbances, but chiefly 
because they are drier and more readily heated, and being 
elevated, are less cut off* from sunlight by surrounding 
buildings. 

The night, should adjoin and communicate with the day 
nursery, and have a good-sized window so placed that it will 
freely admit sunlight during the day. The opening of com- 
munication must be capable of being completely closed by 
a well-fitting door or folding doors, so that one room may 
be thoroughly aired without chilling the other. 

Neither apartment ought to communicate with a bath- 
room having sewer connections; in fact, although it may be 
an object of complaint from the nurse, the further off such 
a bath-room is, the better for the health of the child. 

While it is a matter of difficulty to accomplish in an ordi- 
nary city house, it is, nevertheless, a capital thing to have the 
nurseries in close proximity to, or even in communication 
with, the apartment in which the parents sleep; for then the 
nurse is forced to be morally purer and physically more 
attentive than if she had a section of the house to herself. 

Many mothers prefer to keep their children at night. 

* Nursery windows must always be strongly barred. 



THE NURSERY. 5 I 

Under this condition, the bedroom becomes the night 
nursery, and its situation must be as carefully selected, and 
its hygiene as particularly guarded, as the regular night 
nursery; when, too, there are several children in the family, 
the risk of overcrowding in such apartments must be recog- 
nized and carefully guarded against. The factor of dis- 
turbed rest, by the different hours of retirement of children 
and parents, is, also, one of importance. On all of these 
accounts, a night nursery, under the control of a competent 
nurse, is, in my opinion, to be preferred. 

Size. — The amount of atmospheric air required by a 
healthy child to accomplish thorough oxidization of the 
blood in respiration is about the same as that demanded by 
adults. Therefore the smallest admissible room for either a 
day or night nursery for a single child must have a capacity 
of eight cubic feet. For more than one child the rule ordi- 
narily given is, to multiply this figure — eight cubic feet — by 
the number of individuals. This rule works well enough 
for a family of two or three children, but if the number be 
greater, the size of apartments required would much exceed 
any that could be found in ordinary houses. Lack of space, 
then, must be made up by more perfect methods of ventila- 
tion. To put the question in a more practical form, a room 
nine or ten feet high, twenty feet long and fifteen feet broad 
will readily accommodate, either for playing or sleeping 
purposes, two or three children, with one attendant, provided 
foul air be constantly removed and fresh air supplied by 
ventilation. 

In every room the undermost stratum of air, and the one 
in which the child must pass the greater part of his time, 
whether awake or asleep, has a much lower temperature 
than the middle, and this, again, than the highest — the ten- 
dency of the heated air being always to rise to the top. 



52 HYGIENE OF THE NURSERY. 

Now, the greater the height of the apartment, the cooler 
will be the floor and its neighborhood; consequently, a lofty 
ceiling — namely, one over ten, or, at most, twelve feet — 
while it makes an imposing show, is far from being desirable 
for a nursery, where ease of heating and the comfort and 
health of the occupants are the ends to be attained. On 
the other hand, a ceiling less than eight feet high will tend 
to make the room close, stuffy and over-warm, and corres- 
pondingly unhealthy. 

Lighting. — As already indicated, the only permissible 
light for a day nursery is that derived from the sun, and the 
more plentiful this is, and the more directly it enters, the 
better. The night nursery may be illuminated by gas, by 
an oil lamp, by a candle or a night light. Writers ordi- 
narily recommend the last three, upon the supposition 
that gas, while burning, not only consumes a considerable 
proportion of the oxygen of the air, but gives off certain 
injurious products of combustion. This may be true to a 
certain extent, but the disadvantages are greatly discounted 
by the increase in convenience and the greater safety, so far 
as causing fire is concerned. 

Gas certainly may be used in the late afternoon and even- 
ing; so far as the night hours are concerned, should a light 
be constantly required, the best means of obtaining it is 
from one of the regular night lights. 

A very admirable form of such lights is shown in Fig. 5. 
This light, called the "Pyramid Night Light," consists of 
a low, brass stand, having a movable pyramidal glass chim- 
ney, and provided with a porcelain cup upon which the 
candle rests. The candle itself is about one inch and a half 
in height and breadth, and is so constructed that the com- 
bustible material is completely encased in a fire-proof plaster- 
of-Paris cup. Each candle will burn eight or ten hours. 



THE NURSERY. 53 

These lights are perfectly safe and may be utilized for the 
further purpose of keeping food or water warm. 

For occasional use at night, nothing can be better or of 
more ready service than gas. 

The safest way to make a light is to use a safety match, 
and the taking of a flame from an open fire or the use of 

Fig. 5. 




THE PYRAMID NIGHT LIGHT. 



ordinary friction matches are dangerous and to be strongly 
discouraged. 

Furnishing. — This heading may be made to include the 
finish of the floor, walls and ceiling, as well as the neces- 
sary articles of furniture and their arrangement. 

The floor, which ought to be laid with good yellow pine 
boards, should have a hard finish. To accomplish this, the 
crevices between the boards and all the nail holes must first 
be filled with putty, then, after this has dried, coated with a 
rapidly-drying, hard shellac varnish, next sandpapered, 
when the varnish has had time to harden thoroughly, and, 
finally, finished by a second coat of shellac. This gives a 
light-colored floor that brightens the room and at the 
same time is readily cleaned. A dark staining, besides 
being sombre, always looks soiled. A painted floor is 
not easily cleaned. Should either of the latter be already 



54 HYGIENE OF THE NURSERY. 

in a nursery, they may be overcome by a well-laid parquet 
floor. 

A carpet tacked to the floor is not to be recommended ; 
far better is it to have rugs, which can be frequently taken 
up and well shaken, the housemaid having in the meanwhile 
free access to the floor itself. 

Paint is the best finish for the walls. Individual taste will 
of course weigh in the selection of the color and amount of 
decoration, though a light tint, but still one not trying to the 
eyes, is most desirable. Next to paint, varnished paper is 
to be preferred. Within the past few years light and soft 
tinted fabrics, covered with the representations in figure of 
familiar nursery legends, have been for sale by paper dealers. 
Such papers render the nursery attractive to older children, 
and, to a great extent, take the place of pictures. Paint, 
however, has the advantage, in that it may be washed and 
thoroughly disinfected in case of the occurrence of conta- 
gious disease. 

To return to the subject of pictures, it is best to inter- 
dict any that are valuable or expensively framed. A few 
highly-colored, striking prints taken from one of the good 
weekly illustrated papers, and fixed to the painted wall by 
glue, will give as much pleasure to the childish eye as the 
works of the best artists. They can, too, be changed from 
time to time, and after an epidemic disease can, without 
regret, be removed and burned, in the process of cleaning. 

The ceiling of the rooms should always be painted with 
some light color, and be perfectly free from ornamentation. 

In the matter of furniture, the day nursery should con- 
tain a table at which the older children may take their meals 
or use in play and study; one or more large chairs and sev- 
eral small ones; a plentiful supply of toys and picture books, 
and, if there be room enough, a chest of drawers or ward- 



THE NURSERY. 5 5 

robe for clothing, and so on. All the furniture must be 
plain, that it may be more easily kept clean. 

The centre of the room must be kept clear, to give an 
opportunity for play. The table, therefore, should be a fold- 
ing one, that it may be placed out of the way against the 
wall and take up the least space possible when not in use. 
Any other heavy article of furniture must also occupy a 
position against the wall and be fitted with castors, so that 
it can be readily moved to facilitate cleaning the floor 
beneath. 

The toys may vary in character with the age of the child 
— soft, white India-rubber ones for infants, more compli- 
cated mechanism for older children; but inexpensive toys 
are the best, because they can be most frequently changed. 
The same is true of books. For both, by the way, there 
should be a special drawer or closet provided, where they 
can be put out of the way when not required. 

A few plants, a bird or a globe of fish add brightness to 
the child's room and greatly assist in cultivating good taste 
and in affording amusement. 

The night nursery must contain the beds, the bathing 
and toilet utensils, several chairs — one being a rocker — a 
small table, a medicine closet and a chest of drawers or 
other convenient receptacle for clothing and extra bed 
covering. 

It is essential to have a separate bed for the nurse and 
one for each child ; they should be placed so as to be pro- 
tected from any chance draught of air, be far enough apart 
to allow of a free passage between, and the bed of the 
youngest, or of an ill child, ought to be nearest the one 
belonging to the nurse. 

Old-fashioned pitchers and basins are to be preferred to 
stationary washstands. The latter, though, are so conve- 



56 HYGIENE OF THE NURSERY. 

nient — especially when supplied with hot- and cold-water 
faucets — that they may be permitted when the waste pipe 
is short and runs directly through the wall into a rain spout, 
instead of communicating with the sewer, and when the 
nurse can be trusted not to use them as a convenient means 
of disposing of the ordinary chamber waste. 

Each child should have his or her own brushes, combs, 
sponges, soap and towels, and all of them must be kept clean 
and sweet and have a place of their own. 

The medicine closet must be allowed to contain only such 
articles as may be often required, and can be used with safety 
by a person of average intelligence ; for example, olive oil, 
vaseline, oxide of zinc ointment, talcum powder, soda mint, 
sweet spirits of nitre, syrup of ipecacuanha, chalk mixture, 
etc. Any preparation containing opium — even paregoric — 
is especially out of place in the nursery medicine chest. 

Feeding bottles, implements for the heating and prepara- 
tion of food and for bathing, also belong to the furniture of 
the nurseries, but their consideration may be conveniently 
postponed to later sections. 

Heating. — Each room requires an accurate thermometer, 
so hung that it may record the mean temperature ; not too 
close to the fireplace nor the windows, where it runs the 
chance of being unduly heated or chilled. 

The temperature of the day nursery should range between 
68° and J0° ¥., that of the night nursery from 64 to 68°. 

The proper method of heating is by an open fireplace 
in which either wood or coal is burnt. Either of these fires 
is superior to a furnace, simply because- they serve a double 
purpose, namely, heating and ventilating. My personal 
preference is for an old-fashioned hearth, where oak or other 
quietly burning logs can be used, since a wood fire is more 
readily lighted and regulated, and is a better ventilator than 



THE NURSERY. 57 

one of coals. Still, in our climate, with its manifold and 
sudden changes, it is so essential to have a source of heat 
constantly at hand that it is difficult to banish the furnace 
register from any living room. Therefore, while recognizing 
the disadvantage of furnace heat, in that it makes the air 
too dry, it is well to supply the nurseries with both means 
of heating, using the open-fire in moderate weather and the 
furnace only in the presence of severe cold. 

In my experience, where the nurseries are so situated as 
to receive direct sunlight through ample windows, there is 
rarely any need of furnace heat except in the early morning, 
before the servants have time to make up the wood or coal 
fire. 

Care must be taken to guard every open fireplace with 
a high fender, one that can neither be knocked down nor 
climbed over by an active child. 

Ventilation. — In addition to furnishing ample space in the 
nurseries, it is necessary to provide a constant supply of fresh 
air by ventilation. 

By all odds the best ventilator is an open fireplace in 
which wood is burnt. Such a fire, by creating a draught 
up the chimney, carries off the impure air, and there are few 
doors and windows so closely fitting that they prevent the 
entrance of fresh air to supply the place of that so removed. 

Should this not prove sufficient, one of the windows 
may be utilized, the upper sash being slightly lowered and 
the lower sash slightly raised, the openings being sufficient 
to allow of the entrance and exit of air, but not enough to 
cause a current or draught in the room. 

When the rooms are heated by a furnace or stove, some 
permanent ventilator must be used. For the egress of foul 
air an opening may be made into the chimney at a conve- 
nient distance from the floor ; this may be guarded by an 



58 



HYGIENE OF THE NURSERY. 



ordinary adjustable register, such as is used to regulate the 
entrance of heated air from the furnace flue. 

The same purpose may also be accomplished by making 
an opening in the upper part of the door ; this should be 
guarded by a movable sash, or by one of the ventilating 
appliances to be mentioned later. 

To allow of the free entrance of pure air, one of the glass 
lights may be replaced by a plate of tin having a multitude 
of minute perforations, or a ventilator made to fit the window 
may be used. 

The best of these are shown in the four following figures. 



Fig. 6. 




wmmmm 

WINDOW VENTILATOR. 



The above apparatus consists of two pieces of board, one 
of which slides upon the other, so that it may be readily 
adapted to any breadth of window frame. Each portion 
has a circular opening to which is fitted a tin or sheet- 
iron pipe, eight inches long by four inches in diameter, and 



THE NURSERY. 



59 



having a slight upward bend. These pipes are provided 
with a solid diaphragm, readily moved by a handle, and 
intended to regulate the quantity of air admitted. When 
in position, the pipes, of course, project inward. 



Fig. 7. 




WINDOW VENTILATOR IN PROFILE, SHOWING DAMPER. 



The wheel window ventilator, Fig. 8, consists of a mov- 
able diaphragm and a revolving wheel, the whole varying 
from six to eight inches in diameter. When placed in 
position, which is readily done by cutting a circular hole in 
a window pane or in the door, the difference in temperature 
between the interior and exterior of the rcoms will create a 
current and cause the wheel to revolve noiselessly. The 
revolving wheel, while it prevents a draught, allows of the 



6o 



HYGIENE OF THE NURSERY. 



passage of two currents, that of fresh air inward and foul air 
outward, and the diaphragm enables one to control the 
supply of air. 

An admirable domestic arrangement for ventilation con- 
sists of a board eight or ten inches in height placed across 
and close to the window sill, as in Fig. 9. 

This, when the lower sash is raised, as indicated by the 
dotted lines, allows of a free entrance of air without a draught, 
the current being directed upward (as shown by the arrows). 

Together with the above careful provision for constant 



Fig. 





WHEEL VENTILATOR. 



purification of the atmosphere, it is essential to " air " 
thoroughly both of the nurseries through widely opened 
windows. With the day nursery this must be done when- 
ever the child leaves it for any length of time, care being 
taken to close the windows and get the temperature to the 
proper degree before his return. The night nursery should 
be aired after the children leave it in the morning and after 
the midday nap. 

Cleaning. — It is hardly necessary to say that the nurse- 
ries must be kept perfectly clean. 



THE NURSERY. 



61 



The furniture, woodwork and window glass, as well as the 
floors, must be kept clean and free from dust by wiping with 
a damp cloth at least once a week. 

Should there be a stationary washstand in either room, it 
is most important to thoroughly clean the basin every day, 
and to disinfect the waste pipe, however short it may be, 
twice every week. The latter may be done with ammonia, 
copperas or Piatt's Chlorides. The process is very simple, 



Fig. 9. 





and consists in pouring down the pipe a gallon or more of 
a diluted solution of either of the above articles. Copperas 
is the cheapest and in my opinion the best ; a double hand- 
ful of it in an ordinary bucketful of water forms an efficient 
disinfectant and deodorizer. 

The substance known as Household Ammonia may be 
employed in the strength of two tablespoonfuls^to a gallon 
of water, and is especially useful where there is a suspicion 



62 HYGIENE OF THE NURSERY. 

that the interior of the waste pipe has become coated with 
a layer of soap. 

Piatt's Chlorides is used in the proportion of one part 
to four of water, and is very efficient though more expen- 
sive than either of the other materials. 

Cleaning must never go on while the children are occu- 
pying the nurseries. 



THE NURSE-MAID. 63 



CHAPTER III. 

THE NURSE-MAID. 

While the mother is the'natural guardian of the physical 
and moral welfare of her children, the nurse-maid has a con- 
siderable influence over both ; for the former, however 
anxious and watchful, has so many other duties, both do- 
mestic and social, that she must absent herself at times from 
the nursery ; the latter, on the contrary, lives there. Day 
and night she has the care of the children, attending to their 
apartments, to their persons, food and clothing, participating 
in their amusements and exercise, and watching over their 
sleep. The selection of the nurse-maid, therefore, is a mat- 
ter of much importance. 

The celebrated Dr. West, in discussing the nursing of 
sick children, makes the following statement in regard to a 
nurse's qualifications: " Indeed, if any of you have entered 
on your office (hospital nursing) without a feeling of very 
earnest love to little children — a feeling which makes you 
long to be with them, to take care of them, to help them — 
you have made a great mistake in undertaking such duties 
as you are now engaged in." Now, though this was ad- 
dressed to those who were occupied in caring for ill child- 
ren, it is alike applicable to the nurse whose chief duties are 
with the healthy. 

Love of children, therefore, is essential in a good nurse, 
but it must be combined with several other traits of charac- 
ter, since love alone will not compensate for such faults as 
stupidity, inexperience, forgetfulness and lack of judgment. 

What, then, are the qualifications to be sought for ? 



64 HYGIENE OF THE NURSERY. 

1st. The woman should be in the prime of life, between 
twenty-five and fifty, for example. For if she be under the 
former age, she is apt to be frivolous and think more of her 
" afternoon out " and of her male friends than of her charge, 
while if over the latter, besides being set in her ways and 
opinionated, she is usually too worn out for efficient day 
service and too prone to heavy sleeping to be trusted for 
night duty. 

2d. Strength, activity and freedom from disease are 
necessary. The first quality does not always go with a 
large accumulation of flesh ; in fact, the reverse is apt to be 
the case. A stout nurse looks motherly and comfortable in 
the nursery, but she may, by her very bulk and consequent 
heat-producing power, render a young infant wretched in 
warm weather. I should avoid such an one as much as I 
should another whose back pained when she swept the floor 
or carried the baby out for an airing. 

Consumption of the lungs, indicated by a cough, and 
syphilis, indicated, usually, by an eruption upon the skin, 
are two diseases to be especially avoided. Besides these 
two, which are to be shunned because they positively 
endanger the child's health, there are others that, without 
doing appreciable harm, render the sufferer's presence 
unbearable in the nursery. These chiefly offend through 
the sense of smell, as in the case of old leg ulcers ; too freely 
perspiring feet ; over-active axillary glands ; certain forms 
of chronic catarrh of the nose, throat or tonsils ; and of de- 
cayed or badly kept teeth. 

3d. While beauty is not to be specially sought after, the 
maid's face should, at least, have a pleasant expression. A 
markedly homely or sinister face is a disadvantage, and still 
more so any decided deformity. This reference to personal 
appearance, at first sight, perhaps, seems trivial, but any one 



THE NURSE-MAID. 65 

who has seen much of children cannot fail to notice how a 
young child will crow and hold out his arms to the bearer 
of a placid, comely and smiling face, and turn away from 
one that wears a sombre and unsympathetic expression. 
Much is said about the magic of touch in managing young 
children, but I have observed that their eyes always seek 
the face and eyes of those about them, and that it is what 
they see there that guides their instinct for like or dislike. 

4th. Children resemble dogs and horses so far as the 
instinct of knowing those who love them is concerned, and 
the element of love toward babies is, as already hinted, the 
most important feature in the disposition of a nurse. A 
woman having this quality will never be cross or impatient, 
and, by the very contagion of her good nature, prevents her 
charges from being fretful and makes her nursery happy. 
Besides love, with the patience and consideration it implies, 
truthfulness is a most important trait of character, not only 
for the physical welfare of the child, but also that, since 
children are such imitative creatures, the bad habit of lying 
may not be formed. 

A truthful, loving woman is generally a cheerful one ; if 
not, her place is out of the nursery, for children must be 
happy to be healthy, and the constant contact with sadness 
will bring unhappiness to any child. 

5th. The nurse-maid should have a sufficiently developed 
mind to follow out and remember general directions, whether 
given by the physician or mother, and to do routine work 
without constant supervision. A certain amount of experi- 
ence is a good thing, and on this account it is a recom- 
mendation for a woman to have had a partial hospital train- 
ing, to have nursed children before, or to have been a 
mother. On the other hand, one must beware of the self- 
opinionated maid, who, having cared for several children, 
5 



66 HYGIENE OF THE NURSERY. 

thinks she knows everything, and will be controlled by 
neither professional nor maternal directions. Such women 
are as ignorant and inefficient as they are common. 

6th. Cleanliness is essential in a nurse. A slovenly maid 
will keep neither her children nor their nurseries clean. 
Therefore insist upon the nurse not only washing her face 
and hands as occasion requires, but upon her bathing her 
whole body two or three times a week, and upon her wear- 
ing fresh, well -aired clothing. 

7th. So far as habits are concerned, absolute temperance 
and early rising are the most desirable. Early rising, how- 
ever, implies an early hour of retiring, and care must be 
taken to afford ample facilities for so doing. 

8th. Every nurse-maid should be impressed with the 
importance of informing the parents of all conditions con- 
nected with the health of the child that may demand 
attention, and of revealing at once any injury that may 
have been sustained. 



CLOTHING. 67 



CHAPTER IV. 

CLOTHING. 

In introducing this subject, it may be well to call attention 
to two important points that are often either unrecognized 
or overlooked. 

1st. All children, but particularly infants, have little power 
to resist the depressing influences of continued cold, and on 
this account require warm clothing. 

Too much cannot be said against the fashion which, for 
the sake of supposed beauty, demands that children should 
be dressed in a way to leave their legs and knees bare. 
Even in the house, and except in extreme tropical weather, 
this barbarous practice is injurious, as it exposes a consid- 
erable part of the body to constant chilling. The physician 
knows, and the intelligent layman should be readily con- 
vinced of the bad effects of such protracted abstraction of 
body-heat. The explanation is simple: every child is sup- 
plied by nature with a certain definite quantity of nerve 
force destined to be expended each day in maintaining what 
physiologists term "the functions of the body," namely, 
breathing, circulation of the blood, digestion, heat-produc- 
tion, and so on. Now, if an undue proportion of this nerve 
force be consumed in producing body-heat, as must be the 
case when so large a surface is left bare, the other functions 
must be robbed of force. From this robbery the digestion 
suffers most. With feeble digestion comes constipation 
or its opposite, diarrhcea. Again, if the surface be chilled, 
the blood which should circulate in the skin is driven to 
the interior of the body, and the vessels of the mucous 



68 HYGIENE OF THE NURSERY. 

membrane become surcharged. This surcharging, or con- 
gestion, causes the condition known as catarrh, which, 
affecting the lining membrane of the alimentary tract, causes 
vomiting and diarrhoea; and, in the case of the lungs, 
bronchitis. 

2d. Infants and children have soft tissues. This statement 
applies as well to the bones as to the muscles. Therefore, 
the clothing should fit loosely, that it may not interfere with 
the motion of the limbs, with the rise and fall of the chest 
in respiration, or with the necessary freedom of the muscles 
of the abdominal wall or intestinal canal, one of which is 
concerned in respiration, the other, in the no less important 
function of digestion. 

Let the clothing, then, be warm and loose. 

Thought for the infant's clothing must begin before its 
birth, with the filling of the " baby's basket." This should 
contain the following articles : — 

A nainsook slip. 

A flannel skirt. 

A merino shirt, high neck and long sleeves. 

A flannel band, twenty-two inches long and six inches 
wide. 

A soft woolen shawl, to be used for a wrap in cold weather. 

Worsted socks. 

Two linen diapers. 

Large and small safety-pins. 

One pair blunt-pointed scissors. 

Two soft towels. 

Castile soap. 

Small silk sponge. 

Powder box and puff. 

Soft hair brush. 

Cold-cream or vaseline. 



CLOTHING. 69 

Linen bobbin. 

Fine old linen, for infant's mouth. 

So soon as the child is born and the cutting of the cord 
frees it from maternal connection, it is the rule to wrap it 
in a piece of soft flannel and place it in a position of safety 
until, certain necessary attentions having been rendered to 
the mother, a convenient "time arrives for washing. After 
this operation, which will be described on a future page, the 
child is dressed for the first time. Every infant requires 
knitted worsted shoes, or, as they are popularly called, 
"socks," a napkin and an abdominal belt or "binder;" the 
rest of the dress — the body-clothing proper — consists 
usually of three garments, which vary in pattern with 
individual ideas and tastes. 

The " socks " are made of silk thread or soft worsted yarn 
fashioned by needles into the shape of shoes, and of such 
a size as to fit the foot loosely, while covering the leg two 
inches or more above the ankle. They are held in position 
by a loosely tied tape or a narrowed band of stitches — the 
mechanism of which every knitter will understand — near 
the top. Stockings are unnecessary, and are rarely used 
before the clothes are shortened. 

The napkin or diaper may be made either of linen or 
muslin, the former material being preferred, as it is less 
heating and less liable to cause chafing of the skin when wet. 
It must be folded in such a way that it may not cause pain 
by undue pressure upon the back or abdomen. 

A soiled napkin can never be safely used a second time, 
even though the soiling medium be simply urine and the 
subsequent drying be thorough. In consequence, an abun- 
dant supply is essential. The least dampness renders its use 
dangerous, and while insisting upon the washing of all soiled 
napkins, it is equally important that they be aired for at least 



yO HYGIENE OF THE NURSERY. 

twelve hours before being used again, that they may be 
surely dry. 

The " binder " may be of fine, soft flannel or of knitted 
wool. In either case it should extend from the brim of the 
pelvis or hip bones to the lower ribs. I prefer a knitted 
band made narrower in the centre than at either extremity. 
Any woman who is handy with her knitting needles can 
make one, and the product has the advantages of being 
readily applied and of keeping its position without the aid 
of either strings or pins. * When a flannel band is preferred, 
it should be wide enough to cover the same area, and long 
enough to go a little more than around the abdomen. It 
is best fixed in position by two small safety-pins. Such a 
band is difficult to keep in place, collects more perspiration 
than the more net-like knitted binder, and the necessary 
pins may cause inconvenience. 

Several bands are required to be on hand at the same 
time for the sake of proper cleanliness, and, as they should be 
worn up to the end of the second year, it is necessary to re- 
place them, set by set, as the growth of the child demands. 

The body-clothing is usually composed of three separate 
pieces : a shirt, a petticoat and an outside dress or " slip." 
The shirt should be long enough to extend from the neck 
to the lowest part of the trunk and have sleeves reaching 
to the wrists. It may be made of merino or of soft worsted 
yarn. In either case it should fit loosely and be fastened 



* Formula for Crochetted Baby- Band. — Single zephyr in ridge stitch, that 
is, half stitch, in which, going back and forth, only the back half of the stitches 
in the lower row are picked up. Begin on a chain of fifty and crochet forty- 
eight ridges, hence ninety-six rows. Join by a row of tight stitches or by 
sewing. Finish off at bottom by a row of plain stitches and at top by a picot- 
edging (five chains and a tight stitch back into the first). — " Babyhood," Vol. 
m, p. 33. 



CLOTHING. 71 

at the neck with tape or buttons. The petticoat must be 
long enough to extend from the waist to six or eight inches 
below the feet. Light, white flannel is the proper material, 
and it is usual to sew to the petticoat skirt a muslin "waist" 
which is deep enough to reach from the hips to the arm- 
pits ; this portion of the garment is open behind, so as to 
be readily placed upon the child, and in this position is 
fastened by safety-pins, or, better, by two or three small 
buttons. The dress or " slip " is made of fine cambric, cut 
in one piece, opening well at the back that it may be easily 
slipped on, and the petticoat is fastened by tape or buttons. 

Another, and I think a preferable outfit, consists, also, of 
three garments. The first or under garment, made of soft, 
white flannel, is long enough to extend from the neck to ten 
inches below the feet — about twenty-five inches in total 
measurement — w r ith wide arm-holes and sleeves extending 
to the wrists. All the seams must be smooth, the hems at 
the neck and wrists turned outward, and the opening, 
necessary for ready fitting to the body, provided Avith 
a tie or small button. The next garment, cut in the same 
way, but one-half inch larger, five inches longer and with 
short sleeves, is made of muslin or flannel, according to the 
season, and fastened by two buttons at the neck. The slip 
is also cut " Princess," has long sleeves, a longer skirt than 
either of the other garments, and is fastened behind by small 
buttons. 

When dressing the infant these three coverings are put 
together, sleeve within sleeve, and the whole passed over the 
little one's head, then buttoned behind, and the process is 
complete. 

The advantages oft the last method of dressing are : — 

1st. Perfect freedom to the organs contained within the 
chest, abdomen and pelvis. 



72 HYGIENE OF THE NURSERY. 

2d. Suspension of the clothing from the shoulders. 

3d. Saving of time to the mother and fatigue to the infant 
in the process of dressing. 

4th. A uniform covering of the whole body. 

So much for the day clothing. At night the dress should 
consist of the flannel and the outer garment. 

In the foregoing, my intention has been to lay especial 
stress upon the advantage of holding the garments in place 
by tape or buttons rather than by pins, and it should be 
noticed, that a baby may be thus completely dressed with 
but one pin in its clothing, namely, that fastening the napkin. 
This, which is allowed only for the sake of convenience, 
must be a safety-pin, the ordinary pointed pin being an 
abomination in the nursery. 

It is hardly necessary to say that, for the sake of cleanli- 
ness, an abundant supply of body-clothing should be at hand ; 
a mother, particularly, must recognize that " cleanliness is 
next to godliness," and provide accordingly. Let her 
remember, too, that before fresh clothing be put upon the 
infant it must be thoroughly " aired " or dried. 

Sometimes, to keep the body-clothes dry, a piece of thin 
rubber cloth is placed over the napkin ; this does nothing 
but harm, for it over-heats the parts, and when the diaper is 
wet with urine makes a poultice of it, and thus macerates the 
skin and causes irritating and painful excoriation. 

At the age of six months in summer and of eight months 
in winter, provided, in both cases, the health be good, the 
clothing may be " shortened." This change introduces 
several important questions, namely, the covering of the legs 
and knees, and the selection of shoes and stockings. 

The shortening process makes no change in the body- 
clothing except that the skirt and slip end a short distance 
below the knees, at about the point to which an ordinary 



CLOTHING. 73 

shoe top comes ; this, of course, practically leaves the legs, 
from the stocking top to the lower edge of the napkin, 
exposed. As already hinted, it is necessary for the health 
of the infant to keep this comparatively large surface pro- 
tected, except, perhaps, during a few extremely hot days in 
mid-summer. There are two ways of accomplishing this : 
either by drawers or by stockings long enough to extend 
from the feet to the napkin, to which they may be attached 
by safety-pins or ordinary " fasteners." The best 'drawers 
are those made in two pieces, one for each leg, as shown 
in Fig", io. 



Fig 




DRAWERS. 



These, as furnished in the shop, are made of merino, but 
any clever woman should be able to cut them out of canton 
flannel and make them at home. The point is to have them 
fit the legs moderately closely, and to have a buttonhole at 
the top, so that when passed over the napkin they may 
be buttoned to the waist of the skirt, on its inner side, and 
so held up. These drawers are not readily soiled, as they 
cover the legs only, and the napkin comes between. They 
must, of course, be made of material to suit the season — 
heavy in winter, light in summer. 



74 HYGIENE OE THE NURSERY. 

When stockings alone are used they must be long enough 
to come well above the knees, and should be held in position 
by " supporters " instead of garters, since the latter, being 
necessarily tight, crease the limbs, and often, by interfering 
with free circulation, cause cold feet. The supporter must 
be adjusted to make only the required amount of traction, 
and this always in a direction parallel with the axis of the 
body. The stocking foot ought to fit easily, but without 
wrinkling, and at the same time have a rounded rather than 
a conical-shaped toe. For although the silk, woolen, or 
cotton material of which the stocking is composed may be 
yielding, it is elastic, and consequently capable of exerting 
a certain amount of pressure upon the foot ; and there is 
little doubt that the persistent compression exerted by a 
short, sharply conical point, cramps the toes, crowds them 
together, and sometimes, even, forces them to overlap one 
another. 

Colored stockings soil less readily than white, and while 
not so safe, are permissible, provided the coloring matter be 
well fixed in the texture and not of such a nature as to cause 
irritation of the skin. Every stocking should be turned 
inside out, carefully examined, and all knots and ends 
removed, the smallest of which hurt the tender little feet. 
Were this matter oftener looked to, many an unexplained 
tear would be avoided. 

As with the drawers, so with the hose ; several weights 
should be provided to correspond with the varying demands 
of the seasons for greater or less warmth, and in both 
cases a sufficient supply must be kept to allow of frequent 
changing. 

The shoes are prominent items of the clothing ; their 
shape, size and manner of fastening, and the make-up of the 
soles being the important matters for consideration. 



CLOTHING. 75 

An infant's feet are plumper than those of the adult, and 
all the tissues, but especially the bones, are softer. They 
may be readily deformed by protracted pressure from badly 
constructed shoes, despite the assertions of unhandy shoe- 
makers, who say that the feet are shapeless masses of fat, 
for which any leathern bag having the semblance of a shoe 
will serve as a covering. 

Throwing out the element of fleshiness, the perfectly 
formed baby and adult foot do not differ materially in char- 
acteristics. In the first place, the inner and outer margins 
are very different in contour. Secondly, the heel and 
middle third of the foot is firm and presents little mobility 
in its component bones, whereas the anterior third, including 
the toes, is very mobile. The toes again bear much the 
same relation to the rest of the foot as the fingers to the 
hand. This is particularly noticeable in the great toe, 
which, instead of inclining toward a line passing along the 
centre of the foot, points away from it, in the same manner 
as the thumb from the hand, although, of course, to a far 
less degree. An inclination of the great toe toward the 
mid-line of the foot is undoubtedly often seen in adults, but 
in them it is a deformity resulting from badly made shoes, 
and one that gives a conical contour to the toes, cripples 
the movements of the great toe, and greatly interferes with 
the ease of walking, just as a contraction and permanent 
drawing of the thumb toward the palm of the hand would 
materially lessen the usefulness of that member. 

The normal position of the toes just described will be 
readily understood from the tracing of the sole of the right 
foot as shown in Fig. u. 

The most striking features of this diagram are, the 
expanded position of the toes ; the width of the anterior 
part of the foot compared with the heel, and the straight 



7 6 



HYGIENE OF THE NURSERY. 



outer and curved inner margins of the foot. The line, A B, 
represents the axis of walking, which, while nearly parallel 
to E F, the inner edge of the foot, forms quite an angle with 
C D, the centre line. 

In the normal foot the great toe is directly in the axis of 
walking, a position in which, of course, it is of much greater 
service than if it were inclined inward toward the line C D. 



Fig. ii. 




C A 

TRACING OF NORMAL FOOT. 



Now, if a line be drawn closely around the margin of the 
above imprint, it will give the exact shape of a perfect shoe 
sole for the right foot ; or taking the imprint of both feet, 
we get the outlines shown in Fig. 12. 

On first sight, one would suppose that a shoe with a sole 
so shaped would look very awkward, but when made by a 



CLOTHING. 



77 



skillful shoemaker, it differs very little in appearance from 
those ordinarily sold in the shop, with the exception that it 
is broader in the toes. 

Another important fact is clearly demonstrated by Fig. 12, 
namely, the absolute necessity of having the shoes made 
" right and left," and the fallacy of supposing that one or 
other shoe may be used on either foot indiscriminately. 

Besides having a correct shape, the shoes should be long 



Fig. 12. 




Left Foot. Right Foot. 

SHAPE OF PROPER SHOE SOLES. 



enough not to cramp the toes and bend them down and 
backward upon themselves. At the same time it is a mis- 
take to have them too long, allowing the foot to slide back 
and forth, as this leads to the formation of either blisters or 
corns. Let the shoe fit snugly about the heel and instep, 
and easily at the toes, and all is well. I say easily at the 
toes, because many an otherwise good shoe is ruined by 
having the uppers at the points too scanty, so that the 



yS HYGIENE OF THE NURSERY. 

toes are forced against the sole and subjected to painful 
pressure. 

The best method of fastening is by a lace, since this 
admits of making one part of the upper tight and another 
part loose, according to circumstances. 

Elastic fastenings, as in so-called congress shoes, are not 
good for children, and when buttons are used, the nurse 
must not necessarily leave them in the position fixed by the 
shoemaker, but move one or more as the size of the ankle 
demands. 

The thickness of the soles depends upon the age of the 
child. Before walking is attempted, they may be thin, flex- 
ible and of uniform thickness from heel to toe ; afterward 
they should be made heavier and more resisting, in order 
to protect the tender feet, and should be decidedly thicker at 
the heel, that this part of the foot may be elevated. A clear- 
cut heel, however, as in adult boots, is not to be recom- 
mended in children's shoes before the age of six or eight 
years. 

Sometimes a careful mother may notice that, for a short 
time after stockings and shoes are put upon her baby, the 
feet are cooler than before. Undue pressure about the ankle, 
with consequent interference with the blood circulation in 
the feet, is the cause of this, and to remedy it remove 
occasionally the coverings ; chafe the feet into warmth, 
and see that the shoe-top is not so tightly laced or buttoned 
as to constrict the ankle. 

So far, all that has been said of the clothing after "short- 
ening" refers to the day and house garments. It remains 
now to consider the night dress and the extra wraps to be 
worn out of doors. 

At bedtime, all the clothing worn during the day being 
removed, the baby is washed, and after the application of a 



CLOTHING. 79 

fresh napkin and binder is ready for the night dress. This 
consists of a shirt and an especial gown. The shirt should 
always be of flannel, a light gauze in summer and a heavier 
wool in winter ; its pattern may be the same as that worn 
by day, though its texture ought to be a trifle lighter. The 
best pattern of a winter night-gown is a long, plain slip, 
with a drawing string at the bottom, to prevent exposure of 
the feet and limbs, should the child kick off the bed cover- 
ing during sleep. It ought to be made of flannel, or the more 
easily washed Canton flannel. In summer, a loose muslin 
slip of the same design, but without the drawing string, may 
be worn. There is even more temptation by night than by 
day to use a rubber cloth over the napkin, to protect the 
body and bed clothing, but never do this. 

When dressing a child for exercise in the open air in cold 
weather, do not put on the extra, outer clothing until 
immediately before leaving the house, and remove it directly 
on returning. A long cloak, with or without capes or fur, 
according to the degree of cold, and a pair of long, warm 
leggings, constitute the extra coverings for the body. Pro- 
tect the head, in winter, by a close-fitting, thick cap ; the 
hands by worsted gloves or mittens. 

In summer the child may go out of doors in the same 
dress worn in the house, the head being protected from the 
direct rays of the sun by a broad-brimmed, light straw hat. 

It is a good plan to provide the child with a flannel gar- 
ment corresponding to the dressing-gown of the adult, and 
with a pair of bedroom shoes. The latter are composed of 
soft leather or felt soles and knitted uppers, and are fastened 
around the ankle by a soft elastic. Both of these will be 
found useful in the many occasions when the child has to 
be taken up at night. 

Every mother must decide for herself when her child is 



80 HYGIENE OF THE NURSERY. 

to doff the costume of babyhood and assume that of the 
boy or girl. There are two points that must always be 
considered, however, namely, the time of dispensing- with 
the napkin and with the abdominal belt. Abandon the 
napkin, and substitute ordinary drawers, as soon as the 
child can be trusted to make known the calls of nature — a 
period that varies considerably with the care and skill in 
training. The binder should always be worn until the com- 
pletion of the eruption of the milk teeth, or until about the 
end of the second year. 

In clothing the boy or girl, be particular to secure 
warmth, freedom of movement and cleanliness. The first 
is accomplished by enveloping the whole body — no matter 
what the season — in woolen underclothing. This means 
high-necked and long-sleeved flannel shirts and flannel 
drawers extending down to the ankles. It is hardly neces- 
sary to mention that the thickness of these garments must 
vary with the seasons, but it is quite worth while insisting 
upon woolen under-garments, except during the very exces- 
sively hot days of midsummer. This provision being made, 
and the shape of the shoes and stockings* looked into, it 
matters little what may be the fancy of the mother in regard 
to outer clothing. 

Freedom of movement refers not only to the limbs, but 
to the chest and abdomen, which should never be con- 
stricted, lest the important organs they contain be crippled 
in their action. Loose-fitting clothes accomplish this ob- 
ject; but it is to be understood that looseness or ease in fit 

* It is impossible for either a stocking or shoe to fit accurately unless the toe 
nails be kept in good order. In cutting the toe nails there is, as in every other 
affair of life, a right and a wrong way. Cut the nail directly across, without 
rounding the corners. Should the latter be done, the nail is apt to grow into 
the flesh and give suffering to the child and work to the surgeon. 



CLOTHING. 51 

does not necessarily imply that the dress must be awkward, 
ill-fitting and a source of mortification to the wearer. On 
the contrary, clothes may be easy and yet well cut, and 
stylish. 

To be clean, the child only requires a plentiful supply of 
clothing, so that changes may be made as frequently as re- 
quired. Clean, cheap clothes look much better than soiled 
finery. 

The night dress of a child five or six years old consists, 
during winter, of a light, high-neck and long-sleeve merino 
shirt and night drawers of Canton flannel ; in summer, of 
a gauze undershirt, with short sleeves and muslin night 
drawers. 

Cold weather calls for a warm overcoat, hat, mittens and 
leggings, or rubber boots in wet or snowing weather, when 
the child leaves the warmth of the house. Should the cold 
be so great as to necessitate ear tabs and a neck wrap for 
protection, a child under six years is better off in the 
nursery. 

Before concluding this chapter, let me advise that the 
change from winter to spring or summer clothing be not 
made at any fixed date, under the supposition that it is the 
time to change, and the weather should be warm, whether 
it is or not. In our Eastern climate it is unusual to have 
settled, warm weather until June. May has a certain num- 
ber of warm days, but they are quickly followed by cooler 
ones. Consequently the safe plan is to keep on the heavy 
winter flannels until hot weather surely sets in, changing, in 
the meanwhile, the outer clothing to suit each day. 



82 HYGIENE OF THE NURSERY. 



CHAPTER V. 

EXERCISE AND AMUSEMENTS. 

Healthful exercise, especially when taken in the open air 
and sunshine, invigorates the nerves; secures an active per- 
formance of such vital functions as circulation, respiration 
and digestion ; maintains a hearty appetite and regular 
movement of the bowels, and develops the muscles. 

Symmetry of development is essential, and on this account 
any exercise or play that brings but one or a few sets of 
muscles into action, must be discountenanced. The muscles 
control the bones, and should one set be comparatively 
feeble, the bones they move are dragged out of form by 
stronger opposing sets. Probably the most important groups 
of muscles to render strong are those of the back which 
hold the spine in proper position. When these are weak — 
the greatest weight of the trunk being toward the front — the 
backbone has a tendency to be drawn forward in such a way 
that the movements of the chest are crippled, and respira- 
tion so interfered with, that the blood is imperfectly aerated, 
nutrition fails, and the child becomes a weak, puny invalid. 

Curvature of the spine — the deformity here referred to — 
may also interfere with other functions ; for instance, diges- 
tion, elimination of urine and the motion of the legs. Bone 
deformities are more apt to occur in children than in adults, 
because, in the former, the bones, not being thoroughly set 
and hardened, are more readily influenced by irregular mus- 
cular action. 

Marking, then, the necessity for equal muscular develop- 
ment, the subject of exercise may be taken up in detail. 



EXERCISE AND AMUSEMENTS. 83 

The first exercise the infant gets will be in the nurse's 
arms. Shortly (three or four days) after birth the babe may 
be taken from its crib two or three times a day, and, being 
placed upon its back on a pillow, carried about the room for 
ten or fifteen minutes. In the second month, longer walks 
may be taken, the pillow'being discarded and the infant 
carried in a reclining position in the arms, with the head 
and body thoroughly supported. 

By the fourth month the child will have gained sufficient 
muscular strength to maintain a sitting posture for a short 
time, provided the head and shoulders be supported by the 
nurse's hand, and in this way it may be carried about on the 
right or left arm — and it is most important not to use one 
arm constantly — for its daily training. 

At the end of the eighth month a healthy child ceases 
to require support to the head and back when carried, but 
not before. 

After the infant ceases to be merely a sleeping and eating 
animal, and begins to show signs of humanity, at about the 
fourth month, for example, he should be laid upon a soft 
mattress or sofa several times each day and allowed to do 
as he pleases. 

Under these circumstances, he rolls about and kicks his 
legs, clasps and unclasps his fists, moves his arms, and crows 
or cries. All of these movements serve a purpose; the legs 
gain strength for future walking, the hands for grasping, the 
arms for carrying, and the vocal organs for speaking 

A certain class of nurses seem unable to comprehend that 
a baby is a tender creature ; tender not only in age, but in 
the texture of all its tissues. They support a young infant 
upright upon their knees and violently jolt it up and down, 
under the supposition that it gives pleasure, and should the 
child cry they add to its torment by a peculiar " song." 



84 HYGIENE OF THE NURSERY. 

Gentle movement is as pleasant to the child as riding in an 
easily running carriage on a smooth road to an adult; knee- 
jolting as unpleasant and harmful as a journey over the 
worst corduroy road. The so-called singing must cause 
only pain. 

The question of out-door exercise arises soon after birth. 
Daily airings are requisite for perfect health so soon as the 
child has arrived at the proper age, and providing always 
that the weather be favorable. The fifth month is the proph- 
age for children born in the early fall and winter, and the 
second month, for those born in summer. In cool weather 
they should be taken out in a coach or in the nurse's arms, 
for an hour in the morning and half an hour in the afternoon, 
while the sun is shining. In summer, they may pass the 
greater part of the waking hours in the open air. In damp 
and rainy weather, when there is a strong east or north wind 
blowing, or when the thermometer stands below 20° F., 
young children are better off in the nursery. The hardening 
process, in our climate, so far from being successful, usually 
results in an attack of bronchitis or something worse, which 
may house the child for a long time, and thus deprive him 
of the advantage of subsequent favorable weather. 

How shall the baby be taken out ? The answer to this 
question involves the consideration of two points, namely, 
the clothing and the means of conveyance. The former 
has already been referred to. 

As to the method of conveyance, the arm is to be preferred 
for very young infants, especially in cold weather, because 
they are apt to be uncomfortable in a coach, and because as 
they must, when carried, be held close to the nurse's body, 
they are kept warm by the heat given off from the bearer. 

After the fourth month a carriage may be used. Now 
there are good and bad baby carriages, as well as a right 



EXERCISE AND AMUSEMENTS. 85 

and a wrong way of trundling them; and here again the 
mother must not forget that the baby is a tender creature 
and very easily hurt. 

The best kind of carriage is none too good for the load it 
is destined to carry. It should run smoothly, without jolt 
or jar; its wheels should be kept from creaking by the fre- 
quent application of some mineral oil, as " machine " or 
" sewing-machine oil ; " the bed must be soft and comfortable, 
lateral support being given to the body by two long, narrow 
and soft pillows ; the infant must never be strapped down, 
and the parasol must be always at hand, and so arranged as 
to shade the tender eyes from bright sunlight. 

While the carriage is a convenience to the nurse, it is 
never to be regarded as a place of security for the child, to 
be left on the sidewalks or in windy places while the wheeler 
exchanges gossip with fellow-nurses or enters a house to 
visit friends. However good its springs may be, they are 
never easy enough to allow of rude jolting or of mounting 
a raised curbstone by mere dint of hammering and muscle 
force. 

After the age of nine or ten months, a healthy child will 
begin to creep ; at the end of a year he will make efforts to 
stand, and from four to eight months later will be able to 
walk by himself. Children, however, present great differ- 
ences in this respect, and a delay of a few months must not 
be considered abnormal. Second children are usually more 
active than those born first, since they imitate and are 
encouraged by the example of their elders. 

So soon as efforts at creeping are made there need be no 
fear that insufficient exercise will be taken ; the care should 
be, rather, to prevent over-fatigue, as the babe, delighted by 
its new-found powers, will be inclined to exert them all day 
loner. 



86 HYGIENE OF THE NURSERY. 

So soon as creeping begins, the question arises whether 
or not the nursery floor is a permissible field for exercise. 
This depends entirely upon the child's health, the state of 
the weather and the condition of the nursery. Remember 
always that the stratum of air next to the floor is much 
lower in temperature than the middle or upper. In some 
of the biting days of winter it becomes so cold as to make 
the feet and legs of an adult uncomfortable, and completely 
to chill a child, who, in creeping, has his whole body in it 
for long periods. Therefore, should a child be delicate, 
should he have either bronchitis or catarrh of the digestive 
tract, should the weather be very cold, or should the heating 
of the chamber be imperfect, it is better to keep him off the 
floor and let him take his exercise on the nurse's bed, which 
may be stripped down to the mattress for the purpose. 
Colds are contracted and many more are protracted by 
playing on the floor in winter. 

Many nurses, and some mothers, have an idea that a child 
should walk at a certain fixed age, and when this time 
arrives, put into practice various plans for teaching the pro- 
cess. Beware of this, for go-carts, leading-strings, baby- 
jumpers and all contrivances of this ilk have a tendency to 
flatten the chest, distort the spine or deform the legs. The 
proper and only safe plan is to let the child teach himself to 
walk. This he readily does, first through the act of creep- 
ing, in which he exercises every muscle of the body without 
throwing undue weight upon the soft bones. When by this 
exercise he has sufficiently strengthened the muscles, he 
will instinctively seek to do more, first in an effort to get 
upon the feet, in which, though failure occurs over and over 
again, he perseveres until successful in standing with sup- 
port, then without, and finally ends in walking. 

The first acquisition of the power of walking should not 



EXERCISE AND AMUSEMENTS. 8? 

be over-taxed, and for a month or more the carriage is the 
best means of airing ; but so soon as sufficient strength is 
acquired for active exercise — a somewhat variable age — the 
child should walk out and pass as much time, as the wea- 
ther and nursery requirements permit, in the open air. Set 
walks, however, are an abomination to the child as well as 
to the adult. City-bred children suffer most in this respect, 
as they are too frequently sent out merely to walk a certain 
number of blocks, or for a fixed time, and it is no wonder 
that they quickly tire of such exercise and come to prefer 
their nurseries to the streets. The only way to avoid this 
is to give an object to the outing, as, for example, a house- 
hold errand or the purchase of a cheap toy. In the country, 
on the other hand, children run about and amuse themselves 
according to their own pleasure, visit the garden or the 
farm, and involuntarily take that kind and degree of exercise 
best calculated to promote the growth and development of 
their bodies. 

Delicate, scrofulous and consumptive children preemi- 
nently require pure air and an out-door life, though many 
of them are too feeble to take sufficient exercise on foot. 
For such, when the parents' purse allows, a donkey or a 
pony should be provided. Driving may give sufficient exer- 
cise at first ; but so soon as enough strength is gained, 
riding is to be preferred, as it keeps the mind more health- 
fully occupied, strengthens the muscles, expands the chest 
and produces a healthy appetite and digestion. 

In the earlier years of life the girl and boy play together 
and take nearly the same sort and amount of exercise. As 
time goes on, however, and the girl approaches nearer and 
nearer to maidenhood, she too frequently begins to look 
upon her brother's game of ball or romping play as too 
rough, and spends a constantly increasing time indoors 



88 HYGIENE OF THE NURSERY. 

acquiring the manners and the sedentary habits of her 
elders of the same sex. 

This tendency is often encouraged by parents, who prefer 
polished manners to physical strength, and, above all, dis- 
like their daughters becoming "tom-boys." One must 
admit that polished manners are a great attraction ; but as 
a woman has more important duties than shining in a draw- 
ing-room, they are of little intrinsic value when uncombined 
with the fine carriage and the good figure which belong only 
to robust health. 

In regard to the carriage and figure, it is useless to try to 
assist their formation by the aid of braces and corsets. The 
latter are especially to be condemned, as, unless most cau- 
tiously used, they induce undue contraction of the lower part 
of the chest and displace the solid organs (liver especially) 
of the abdomen, interfering primarily with respiration and 
digestion, and secondarily with the general processes of 
nutrition. The means by which they are secured are : 
attention to the general health; suitable diet; regulation 
of the bowels; exercise short of fatigue, and not of par- 
ticular muscles only, but of the whole frame, and cold 
bathing and sponging. 

My advice, therefore, is to let the girls join in the boys' 
play. By this plan the latter gain, because they are natu- 
rally forced to be more gentle, and the former, because their 
rapidly-developing frames get the requisite amount of exer- 
cise. In addition, let me say, be careful to curb the 
ambition of the girls to equal the athletic powers of the 
boys, for their muscular strength is less. Secondly, with- 
out letting the subjects know, keep a good lookout upon 
the general morals ; for it is absurd to shut one's eyes to 
this risk in mingling the sexes in later childhood and 
youth. 



EXERCISE AND AMUSEMENTS. 89 

Amusements. — A child's life must be devoted to the culti- 
vation of his mind and his body, an undue development of 
either resulting in an incomplete manhood or womanhood. 

After writing the above sentence I was called from my 
desk to the bedside of aiittle sufferer, and on my way met 
two boys, both about nine years of age, and both patients 
of mine. The first had a spirituelle face, and spoke to me 
with a tip of the hat and the grace of a little Chesterfield ; 
but his features were pinched, so it seemed to me, while his 
face was anxious and his legs were hardly thick enough to 
carry his body. Nevertheless, his arms were full of books, 
which, as I had curiosity enough to examine, I found to be 
a Greek grammar, Caesar and the elements of algebra. I 
felt sorry for the overtaxed little brain, and he showed no 
symptoms of joy at release from school, for he was on his 
way home to study all his books, to get the teacher's ap- 
proval and a high mark on the morrow. Scarcely a block 
away I met my next little friend ; his cheeks were rosy, his 
arms and legs sturdy, and his eyes brimful of health and 
fun. The burden of books he bore was light, and his teacher 
probably considered him stupid ; but his simple " Halloo, 
Doctor, I am off for a game of ball this afternoon," and his 
jolly smile, were more pleasing than all the learning of the 
first little gentleman. 

The lesson taught by these two children is very plain to 
my mind, and the question which will come out ahead in 
the long run is easily answered; for health has no handicap 
in the race of life. 

It is right, of course, to let the children study — after the 
sixth year; but the brain is not to be cultivated at the ex- 
pense of the body ; in other words, they must have plenty 
of play. 

The subject of childish diversion is a broad one, and it is 



90 HYGIENE OF THE NURSERY. 

only possible to outline it here. Let the healthy child play 
as much as possible in the open air, and let him be as active 
as he pleases ; for his own sensations will tell him when to 
stop and when to begin again. The only cautions are not 
to overlook him too much ; to let him make as much noise 
as he wishes out of doors and in his own kingdom — the 
nursery; to make him play those games which will exercise 
all the muscles of the body equally, and to guard him, when 
heated, from drinking ice water or from lying on the cold, 
damp ground or sitting in a draught. It must be remem- 
bered, also, that play is the child's business, so that during 
convalescence from a debilitating disease it must be regu- 
lated according to the strength. 

Before closing this chapter a protest must be entered 
against roller-skates and bicycles ; the first are dangerous to 
life and limb, and the last, though not so liable to result in 
broken limbs, produces, from the position it is necessary to 
assume, a narrowing of the upper portion of the chest. 



SLEEP. 91 



CHAPTER VI. 

SLEEP. 

For some time after birth infants spend the intervals 
between being fed, washed and dressed, in sleep, and thus 
pass fully eighteen out of the twenty-four hours. As age 
advances, the amount of sleep required becomes less, until 
at two years thirteen hours, and at three years eleven 
hours, are enough. The amount of sleep required will, 
however, vary considerably in different children, but an 
observant mother can soon determine this question for 
herself. 

Any marked diminution in the average duration of sleep, 
or any decided restlessness indicate disease, and demand 
attention from the physician. At the same time, sleep is, 
perhaps, more a matter of training than any other item of 
nursery regimen, and many a mother, by want of judicious 
firmness, has rendered the early years of her child's life not 
only a burden to himself, but an annoyance to the entire 
household. 

One cannot too soon begin to form the good habit of 
regularity in sleeping hours, and so far as circumstances 
admit, the following rules may be enforced : — 

From birth to the end of the sixth or eighth month the 
infant must sleep from 11 p.m. to 5 a.m., and as many hours 
during the day as nature demands and the exigencies of the 
nursery permit. This does not mean that the baby is not 
to be put to bed until nearly midnight; on the contrary, he 
should practically settle for the night at six or seven o'clock, 
but the last feeding should be at eleven o'clock, and after he 



92 HYGIENE OF THE NURSERY. 

must rest undisturbed until the early morning hour, when 
he should sleep again. 

From eight months to the end of two and a half years, a 
morning nap should be taken, say from 12 m. to 1.30 or 2 
p.m., the child being undressed and put to bed. Occasionally 
an afternoon nap for half an hour or more seems to be neces- 
sary, though, as a rule, sleep at night is more undisturbed 
and refreshing if this be omitted. The night's rest must 
begin at 7 p.m. If a late meal be required, the child can be 
taken up at about ten o'clock, but if past the age for this, he 
may sleep undisturbed until he wakes of his own accord, some 
time between 6 and 8 a.m. So soon as thoroughly awake the 
child must be taken up, washed and dressed, and given break- 
fast. This is the only way to cultivate the habit of early rising, 
which promotes both bodily and mental welfare, and of all 
habits is the most condu-cive to a long and healthy life. 

Here again it is necessary to make an explanation. By 
early rising it is not meant that the child shall be roused 
from a sound sleep by a rough voice or hand at a certain 
fixed hour in winter and an earlier one in summer, simply 
on the whim of a fad-ridden and over-prompt parent. Quite 
the reverse. Let the child wake of his own accord, for he 
will do so — whether it be late or early — when he has had 
enough sleep ; at all events, if he must get up at a certain 
hour — and never fix it before 7 a.m. — make the rousing pro- 
cess as gentle and gradual as possible. Sudden rousing 
excites the brain, quickens the pulsation of the heart, and, if 
repeated, may lead to serious consequences. 

From two and a half to four years, an hour's sleep may 
or may not be taken in the morning, according to the dis- 
position and needs of the subject, but in every case the bed 
must be occupied from seven in the evening to six or seven 
o'clock on the following morning. 






SLEEP. 93 

After the fourth or fifth years, few children will sleep in 
the daytime ; they are ready for bed by 8 p.m., and must be 
allowed to sleep for ten hours or more. 

A later retiring hour than 9 p.m. ought never to be 
encouraged until after the twelfth or fifteenth year. Any 
postponement of the usual hour for going to bed is injurious, 
and should abridgment of sleep be accompanied by the 
excitement of a child's party or the like, the rest obtained 
is broken and productive of a pale face and nerveless frame 
on the succeeding day. 

The position and general features of the night nursery 
have already been described, and it only remains to say that 
when occupied by day it must be darkened so as to favor 
sound sleeping. 

The bed (and where there are several children in the 
family each should have his own) must be so situated in 
the room as to be out of the way of draughts. Curtains, 
while they protect, prevent the access of fresh air, and it is 
far better to ward off a draught by a movable, folding 
screen. 

The form of bed known as a " crib " may be occupied until 
the sixth year. The sides must be high, to prevent the child 
from falling out and injuring himself, and the movable side 
should work upon hinges rather than move up and down in 
slots. 

Springs and a soft horsehair mattress, protected by a gum 
cloth, placed under a double sheet, constitute the bed proper, 
under ordinary circumstances. Sometimes a feather mat- 
tress is admissible, but this is only when the child is feeble, 
and requires artificial aid to keep up the normal body-heat 
during sleep. 

The objection to feathers is, that the body, sinking deeply 
in, is completely enveloped and subjected to an undue degree 



94 HYGIENE OF THE NURSERY. 

of heat, which relaxes and weakens the system and renders 
it very susceptible to the injurious influences of cold. 

The bed-covering is composed of a sheet, one or more 
blankets — according to the weather — and a spread. These 
must be warm enough to maintain a healthy temperature, 
but, at the same time, not so heavy as to oppress the child. 

Especial care should be taken not to cover the nose or 
mouth, and it is much better to keep the air of the nursery 
at a proper, even temperature by an open fire than to secure 
warmth to the body alone by weighty bed-coverings. 

The pillow ought, to be small, rather thin than the reverse, 
and made, except for very young infants, of soft horsehair. 

A bed should never be made up directly upon the child's 1 
leaving it, for then it is saturated with the nocturnal exhala- 
tions from the body. So soon as vacated the bed-coverings 
must be thrown over the backs of chairs, the mattress shaken 
up, and, the windows of the chamber being thrown open, 
allowed to air for an hour or more. 

In the matter of bed-clothing, cleanliness is as important 
as in body-clothing, and the nurse must never neglect to 
re-make a bed if the sheets become wet with urine or other- 
wise soiled, no matter at what hour of the night the acci- 
dent may occur. Much trouble in this direction may be 
avoided, however, by regularly taking up the child at the 
time of the last feeding and encouraging a thorough evacua- 
tion of the bladder. 

Besides having separate beds, children should never sleep 
in the same room with persons who are ill, whether the dis- 
ease be acute or chronic. Sleeping with those having a 
long-standing cough or consumption of the lungs is espe- 
cially to be avoided. Do not get the baby into the habit 
of being rocked or walked to sleep, and do not allow older 
children to sleep too soon after a meal, as the processes of 



SLEEP. 95 

digestion are apt to produce restlessness and uneasiness. 
Again, a bright light or conversation in the bedroom is 
never to be permitted after the children have settled to rest. 
Finally, teach the nurse to make up the bed neatly and 
smoothly, and direct her fo turn the pillow and smooth out 
the sheets, should her charge be restless at night. By this 
latter procedure sound sleep is often brought to a fretful 
child. 



96 hygiene of the nursery. 



CHAPTER VII. 

BATHING. 

A well-known English writer states, that " water to the 
body — to the whole body — is a necessity of life, of health, 
and of happiness; it wards off disease, it braces the nerves, 
it hardens the frame, it is the finest tonic in the world." 

On the word "tonic" the whole subject hinges. Every 
one knows that food, even in such a simple form as milk, 
may be given to excess, with the production of illness, and 
that medicines are yet more easily abused. Why, then, 
if the bath be a tonic agent, may it not be often used 
injudiciously and to the detriment of the child? 

Intelligent nurses who have grown gray in service, often 
say that they have seen babies " washed into heaven." 
This act has never been actually accomplished in my 
experience, but it has been oftenvenough approached to 
justify introducing this chapter with the caution that, should 
the infant be ailing, the bath had better be discontinued 
until the physician can be consulted. This, of course, does 
not preclude ordinary cleanliness, for every part of the 
child's body liable to become soiled can be readily cleaned 
by the use of a moist sponge, with or without soap, and 
without bringing into play any of the medicinal or, in other 
words, tonic effects of the bath. 

The initial bath is to be given as soon after birth as the 
nurse, having made the mother comfortable, can turn her 
attention to the child. This bath differs somewhat from 
those that succeed it during infancy, in the fact that it 
involves a special procedure, namely, the removal of the 



BATHING. 97 

tenacious, paste-like material which usually adheres to the 
skin of the newly-born. 

This substance, the vernix caseosa, is a fatty varnish or 
deposit secreted by the glands of the skin. While the 
foetus is in the womb, it probably acts as a protecting agent, 
but if allowed to remain long after delivery, it becomes dry 
and hard, and, in addition to impeding the healthy activity 
of the skin, leads to excoriations or various eruptions. 

To remove it, the whole surface must be first gently, 
though thoroughly, rubbed with a bit of flannel smeared 
with fresh lard or olive oil ; next, the softened and greasy 
coating is washed off by a sponge with warm water and 
soap, and finally the bath is completed by immersing the 
body in warm water for one or two minutes. 

After this preliminary cleansing, one bath a day should 
be the rule until the completion of the third year of life. 

The monthly nurse, must bathe the child while she re- 
mains in attendance ; afterward the mother is the proper 
person, unless the nurse-maid be exceptionally careful and 
experienced; and even in this event the mother should 
superintend the process. 

A tub with a supply of water, a piece of soft flannel for 
a wash rag, a fine sponge, a bit of good soap and several 
soft towels are the necessary utensils. A long apron made 
of soft flannel is also a useful article, and it is well to pro- 
vide a low chair and a bit of oilcloth to place on the floor 
underneath the tub — the former to enable the bather to get 
more on a level with her work and make a deeper lap for 
the child to rest in, and the latter to receive any water that 
may be splashed about. 

An ordinary, oblong tin tub, painted white inside and 
large enough to give plenty of room is to be preferred to 
either a porcelain basin or a wooden tub. When in use, 
7 



98 HYGIENE OF THE NURSERY. 

the tub should be placed on the floor, for the sake of firm 
support, and afterward must be well cleaned, dried and 
aired. 

Water for the bath ought to be pure and soft, and should 
it be muddy or otherwise foul, the nurse must take the 
trouble to filter it. The character of softness is an important 
one, and when it is impossible to obtain anything but hard 
water from the ordinary sources of supply, a special provi- 
sion ought to be made for the collection of rain water. The 
quantity used at a time should be sufficient to cover the 
child up to the neck when placed in the tub in a semi- 
reclining position. 

A matter of great importance is the temperature of the 
water. Some — fortunately very few — people use cold water 
from the first, under the impression that it is strengthening. 
So far from this being the case, cold water, instead of " hard- 
ening," depresses the vital forces and frequently produces 
conjunctivitis, nasal catarrh and inflammation of the lungs 
and bowels. 

While cold baths are not to be recommended, one must 
not go to the other extreme, and use too hot water; for 
this also weakens the frame and renders it more susceptible 
to the attack of disease. 

Ninety-five degrees Fahrenheit in winter and from eighty- 
five to ninety-two degrees in summer is the proper tempera- 
ture. As the heat of water cannot be estimated by the 
hand with any degree of accuracy, it is essential to use a 
bath thermometer. See Fig. 13. 

Place this instrument in the water and allow it to remain 
a few moments, so as to get a full effect upon the mercury ; 
then, should the water be too hot, it may be readily cooled 
by the addition of cold water, or, if too low in temperature, 
as easily raised to the proper degree by pouring in hot water. 



BATHING. 



99 



Fig. 




It is impossible to insist too strongly upon the necessity 
of uniformly using the bath thermometer. Several times 
in my experience a tin bath tub has been filled with water 
so hot that its sides burned the delicate skin of 
the little hand placed upon it ; fortunately, in 
such instances, the consequent screams led to 
careful investigation, and no serious damage 
resulted. On the other hand, I have felt the 
water cold enough to pain the fingers. Don't 
neglect the thermometer, then ! 

A piece of flannel is very useful for the first 
part of the bathing. It readily takes soap, and, 
being soft, can be thoroughly rubbed over the 
skin without danger of injury. A large, soft 
sponge, however, is best suited to the finishing 
of the bath, for it holds much more water than 
a flannel wash rag, and enables the bather to 
stream the water over the child's body, and thus 
get the stimulating effect of a miniature shower 
bath at the same time that the dirt and superfluous 
soap are washed away from the surface. The wash 
rag and sponge must, by the way, be the child's 
exclusive property, and are not to be used twice 
in succession without being thoroughly cleaned 
and dried in the open air. 

Unscented Castile or glycerine soaps are the 
best to use. Common soaps are irritating to the 
skin, and even the purest and most bland articles 
must be employed with care, that is, neither too 
frequently nor too profusely, lest they lead to 
eczema or other cutaneous disorder. When any 
skin disease is present, the physician's advice must be had 
not only as to the use of soap, but also in reference to the 
propriety of the bath itself. 



71 
i 



BATH 
THERMOMETER. 



IOO HYGIENE OF THE NURSERY. 

Two towels are required for each bath. These should be 
large and composed of fine, soft material. They must be 
dry and warm, and perfectly clean, before they are applied 
to the surface of the child. 

The bath apron is made of soft, white flannel, and should 
be long enough to extend from the neck to the feet of the 
bather and broad enough to cover the whole front of her 
gown. Of such a size and shape it serves two purposes ; 
first, a protection to the nurse's clothing, and secondly, a dry 
and warm covering in which to receive and wrap the child 
when removed from the water. After the bath the apron, 
being more or less wet, must be taken off and thoroughly 
dried. Several such articles should be provided, as they 
must be frequently washed to keep them clean and free from 
odors. 

Any low chair will do to use in bathing, though, as those 
usually sold in the shops have not a sufficiently broad seat 
to give a comfortable support, it is better to make one by 
sawing off the legs of an ordinary wooden kitchen chair. 

The bath must be given at a regular time each day. 
The two best hours are in the morning, midway between 
two feedings, at ten o'clock, for instance, and in the evening, 
just before the infant gets his last bottle and goes to bed. 
The first is perhaps the better hour, but regularity is the 
greater point. 

At the hour selected, place the tub containing the water, 
heated to a proper temperature, in a warm and sheltered 
part of the room, and around it arrange, within convenient 
reach of the hand, the various requisites of the bath. 

Upon undressing the child, wet his head first; then let 
the head and shoulders rest on the left forearm and lower the 
child gently into the water, that his body may be covered 
as far as his neck. Take a wetted and soaped flannel wash 






BATHING. 101 

rag in the right hand, and pass it rapidly but thoroughly 
over the body, avoiding the eyes. Pay particular attention 
to the arm-pits, to the region between the folds of the but- 
tocks and to the groins. - This done, take a large, well-filled 
sponge in the right hand and squeeze the contents over the 
body. The chief force of this miniature douche must fall 
upon the back and loins, and the child, during the opera- 
tion, must be lifted clear of the bath-water by the left arm 
and hand 

The sponge is used simply to clear off the dirt loosened 
by the wash rag, and to remove all superfluous soap ; there- 
fore, so soon as this is accomplished, the child should be 
lifted from the tub to the lap and enveloped in a towel, or 
better still in the loose folds of a bathing apron. The drying 
process now begins and consists in absorbing the moisture 
from the skin. This is done by a series of very gentle pat- 
ting movements with a towel folded over the palm of the 
hand. In drying a baby, especial attention must be given 
to the ears and to those portions of the body where the 
natural folds give rise to crevices in which water may lodge. 
Unless these parts be thoroughly dried, serious consequences 
may ensue. Water allowed to remain in the ears may 
lead to ear-ache and abscesses, and in extreme, though not 
rare cases, to deafness. If it be retained in a normal crev- 
ice — the fold of the buttocks or behind the ears — it causes 
in a short time troublesome excoriation. 

After the infant is patted perfectly dry, the whole surface, 
but especially the region on each side of the spine, should 
be rubbed with the naked palm until the skin becomes 
slightly red. This modified massage ends the bath, and the 
child, enveloped in a light blanket, may be either placed in 
his crib to sleep or kept in the lap for ten or fifteen minutes 
until thoroughly warmed and rested, and then dressed. 



102 HYGIENE OF THE NURSERY. 

Several important points yet remain to be mentioned. 
The time of actual immersion in water must never exceed 
five minutes ; the body must never be suddenly or rudely 
plunged into the water; the drying process must never be 
one of rude rubbing with the towel ; a bath must never be 
given immediately after a meal, nor when the child is either 
cold or very hot, and the face and head must never be 
allowed to dip beneath the surface of the water. 

Should the latter happen, the child will become so fright- 
ened that it will be difficult to get him to enter the water 
again; and here, by the way, it may be well to state that if 
there be repugnance to the bath, the tub may be covered 
over with a blanket, and the child being placed upon it, may 
be slowly lowered into the water without seeing anything to 
excite his fears. 

The question of the propriety of using powder after a 
bath is often asked by mothers. Powdering has always 
seemed to me to be a lazy way of absorbing moisture that 
should be taken up by a dry towel, and unless there be some 
excoriation or other indication for its use, the skin can be 
kept cleaner and healthier without it. In cases, too, in which 
some disorder of the skin would seem to warrant its employ- 
ment, much better and quicker results are ordinarily obtained 
by the application of cold cream, oxide of zinc ointment or 
vaseline. 

The rule of one bath a day may be exceeded in very hot 
weather, when, in addition to the morning full bath, the body 
may be sponged twice daily with water at a temperature of 
90 F. This, contrary to what might be expected, has a 
greater and more permanently cooling effect than bathing 
with cold water. 

From what has been written, one might suppose that the 
details of an infant's bath are endless ; so they must seem 



BATHING. 103 

when given in full. A skillful bather, however, ought to 
fulfill every requisite and complete the bath in a period of 
time not exceeding twenty minutes at the very outside, and 
this must include not only the actual five minutes' immersion, 
but the preparation of the bath and the drying process. 

After the third year three full baths a week are quite 
sufficient. An evening hour is now to be preferred, but the 
water must still be heated to 90 F. in winter, though it may 
be cooler in the heat of summer. While, at this age, the child 
has his three full baths weekly, for the purpose of securing 
absolute cleanliness, he must be sponged every day with 
water, cool or warmed according to the season. 

The sponge bath is best given in the morning, soon after 
the child has roused himself from sleep and before any food 
is given. The nurse, for this, must provide herself with a 
large basin containing water at a temperature of 75 ° in 
summer and 85 ° in winter, a large, fine sponge and several 
towels. The bath-apron being donned and the child's night- 
clothes removed, the sponge filled with water is passed rap- 
idly over the whole surface of the body ; then the child must 
be wrapped up in the apron and the skin first dried gently 
with a soft towel and then rubbed into redness with the open 
hand. When this process is completed — and it should be 
done in at least ten minutes — the clothing is put on rapidly, 
and the child is ready and usually hungry for his morning 
meal. No soap need be used in these baths. 

In the tri-weekly cleansing bath the process of washing is 
much the same as in infancy. That is, the bath tub being 
filled with water at a temperature of about 90 , the child is 
put into it up to his neck and thoroughly soaped with a 
wash rag, and next douched clean with a large sponge. 
Here, also, the head must be wet first ; the body immersion 
must not last longer than five minutes; the drying must be 



104 HYGIENE. OF THE NURSERY. 

done quickly and with a patting rather than a rubbing 
movement, and ample reaction of the skin must be secured 
by gently rubbing with the palm of the hand, especially over 
the spine. 

The washing of the head is a most important matter, as 
it cleanses the scalp and prevents the formation of scurf, and 
adds beauty to the hair. At the same time the nurse must 
be careful how she dries the hair. To rub it gently with a 
soft towel and then brush it out with a fine hair brush is the 
proper plan. Combing, in so far as it means dressing the 
hair and cleansing the scalp with a fine comb, must never 
be allowed, as it not only thins the hair by pulling it out by 
the roots, but also irritates the skin and produces eruptions 
upon it. 

As the child approaches puberty he must gradually be 
taught to wash himself, and should be encouraged to form 
the habit of bathing every day. The bath at this age should 
be a sponging rather than a soaking process ; it is best taken 
in the morning directly after rising, and the temperature of 
the water may range from 65 ° to 75 °, though delicate 
children may require it warmer, especially during winter 
weather. 

When childhood merges into youth, while the sponge 
bath is still preferable to the plunge, water may be used, all 
the year round, just as it flows from the faucet. The 
temperature will be, of course, quite low at times, but so 
long as the bath is taken in a warm room, completed 
quickly, and followed by a sense of stimulation and warmth, 
nothing but good results. 

Whatever room be used for the purpose of the toilet, the 
child, if he be old enough to bathe himself, should occupy 
it alone, so that the whole body may be stripped naked ; 
otherwise washing cannot be thoroughly or effectually 



BATHING. 105 

accomplished. The paraphernalia required are: a large 
basin, a tin chamber tub or the ordinary fixed bath tub ; a 
piece of coarse flannel, one yard long and half a yard 
wide ; a large sponge ; a tablet of soap ; a soft towel and 
a Turkish bath towel. 

Having drawn a sufficient quantity of water — two-thirds 
of the basinful, or two or three inches in either of the tubs — 
the successive steps of the bath are as follows : wash the 
hands with soap ; dip the head and face into the water ; re- 
soap the hands and rub and wash the head, face, neck, chest, 
and arm-pits ; take the wetted sponge and go all over the 
parts previously covered by the soaped hands ; fold the 
flannel into a long band, dip it into the water, and, holding 
an end in either hand, throw it over the shoulders, and 
move it several times from side to side, then up and down, 
and then across the back and loins ; dip the sponge into 
water again, and holding the head and shoulders over the 
tub, stream the water once or twice over the head, neck and 
face ; step into the bath, re-soap the hands and pass them 
quickly up and down the legs and over the feet. Fill the 
sponge and squeeze its contents over each leg ; finally, sit 
down and with soaped hands wash the region between the 
buttocks, removing the suds by a few splashes of water. 
Next, step from the tub and dry the body quickly, taking 
care to remove all the moisture from the ears, from between 
the toes and from the different folds of the body. The 
drying is to be accomplished by brisk rubbing, first with 
the soft towel and then with the Turkish towel. The 
back and loins are the most difficult to reach, but if the 
towel be thrown over the shoulders, as one would a 
skipping rope, and moved from side to side several times, 
the drying of these out-of-the-way parts is accomplished 
without trouble. 



106 HYGIENE OF THE NURSERY. 

A boy should wash his head as above described each 
morning ; a girl, who has long hair, at least once a week. 

Any loitering over the bath is attended with the danger 
of chilling. Never occupy more time than fifteen minutes 
in the whole process. 

These daily sponge baths are ordinarily quite sufficient 
to keep the person perfectly clean ; sometimes, however, it 
is necessary to take, in addition, a full, warm bath at intervals 
of a week. These baths are relaxing if too prolonged ; ten 
minutes is the maximum time for remaining in the water. 
After leaving the tub there must be no exposure to draughts. 
The best hour for such a bath is in the evening ; some time 
after the last meal and just before going to bed. 

Sea-water baths are useful for a child of any age, although 
ordinary sea bathing is not to be recommended until the 
child is old enough and strong enough to hold his own in 
a moderate surf — after the eighth year, for instance. A 
younger subject may, when at the seaside, be dressed daily 
in a bathing suit and allowed to splash for a time in salt- 
water pools left by a receding tide, or at the edge of the 
surf. The process of carrying the child into the waves and 
the immersion of his head, as is often done, is cruel and pro- 
ductive of so much terror that more harm than good results. 

In our climate, the proper season for sea bathing is the 
summer and early fall: from the middle of June until the 
first of October. 

On arriving at the coast, it is always well to prepare for 
the plunge in the sea by giving, on the first day, a warm 
salt-water bath. On the day following, about three hours 
after breakfast, the child may don his bathing dress. Imme- 
diately on entering the water, the head must be thoroughly 
wetted. After this, the bath may be protracted for fifteen, 
or at most twenty, minutes. To get the invigorating effects 



BATHING. 107 

of a surf bath, it should never be repeated oftener than once 
a day, and in some cases it is better to allow a day to inter- 
vene, or even to enter the water only twice a week. Drying 
and dressing should be rapidly performed, and a half-hour's 
brisk walk is very useful in promoting reaction and causing 
free circulation of the blood. Should the bather feel faint 
after coming out of the water, he must be wrapped in towels 
and given half a tumblerful of milk containing one or more 
teaspoonfuls of brandy or whisky. 

When the child is either cold or perspiring freely, the 
bath must not be undertaken. 

The bathing suit should be of light flannel, made in one 
piece like a pair of moderately loose night drawers, but with 
short arms and legs; it should open only over the shoulders, 
where, when put on, it is fastened by buttons. This arrange- 
ment permits of easy removal after the bath when the flannel 
is saturated with sea water, and is, in consequence, heavy 
and sticky. 

The question of sea bathing suggests that of swimming. 
Boys, and girls, also, should learn to swim early. The art 
is not only a safeguard, but a means of most pleasant and 
invigorating exercise. It develops the muscles, expands 
the chest, aids digestion, strengthens the whole frame, and 
promotes energy, courage and self-reliance. 

Swimming, like every other exercise, must be taken in 
moderation. Even with this care it is not always beneficial. 
The bather should leave the water experiencing a pleasant 
glow over the whole surface of the body; the spirits and 
appetite should be increased, and there ought to be a 
sensation of augmented strength. If, on the contrary, it 
should disagree, there is a sense of chilliness, with lassitude 
and depression of spirits; the face is pinched and pale, and 
the lips and finger nails are apt to look blue. 



108 HYGIENE. OF THE NURSERY. 

Swimming in salt water is more invigorating than in fresh. 
Apart from the different quality of the two waters, the 
battling with the waves in the former case is more exhila- 
rating, and the sea breezes, blowing upon the body, carry 
with them health and strength. Every one must have 
noticed the increased softness and beauty of the skin and 
the greater lustre of the hair after a sojourn at the seaside. 

It may be serviceable next briefly to detail the different 
baths in common use, with some reference to their effects 
upon the system. 

Concerning temperature, the bath may be : — 

I. Cold, temperature 50 to 65 F. 



2. Cool, 

3. Temperate, 

4. Tepid, 

5. Warm, 

6. Hot, 



65 to 75 " 

75 to 85 « 

85 to 92 " 

92 to 98 " 

98 tO 112° " 



When giving a cold bath, strip the child in a warm room, 
and rub him thoroughly with the palm of the hand until the 
whole body, especially the spinal region, is warm. Let him 
then stand in a tub containing enough hot water to cover 
the feet, and sponge him rapidly with the cold water. The 
temperature of the latter must never be below 6o° F., and 
the addition of half an ounce of rock salt or a tablespoonful 
of concentrated sea water to the gallon, renders it more 
stimulating and insures a complete reaction. After spong- 
ing, the surface must be thoroughly and quickly dried with 
a soft towel and shampooed with the open hand until aglow. 

This bath, provided the degree of cold does not exceed 
the resisting powers of the child, is a powerful tonic, pro- 
ducing rapid tissue changes and increasing nutrition. 
Should the water be too cold, or the sponging continued 
too long, reaction does not follow the primary shock, and the 



BATHING. IO9 

result is fatigue, exhaustion, or even dangerous prostration. 
This bath, therefore, must be used with caution and only 
under a physician's advice. r The cases in which it is of most 
service are those in which there is a sluggish circulation 
with poor appetite and feeble digestion ; in which the nutri- 
tion is impaired, as in rickets, and in certain spasmodic 
nervous disorders. 

A cooled bath is sometimes prescribed, and may be 
employed with advantage in conditions attended with very 
high fever. The child is first immersed in water at 95 °, 
and this is gradually lowered to jo° by the addition of cold 
water, the process occupying from fifteen to thirty minutes. 

Analogous to this bath is the cold pack. Fold a sheet 
in such a way as to be long enough to extend from the 
child's arm-pits to his feet, and wide enough to encircle 
completely his body; dip it in water at 8o° and lay it 
smoothly upon a cot, the mattress of which must be pro- 
tected by a rubber Mackintosh. When all is in readiness, 
place the child upon the sheet, and wrap it around his body 
and legs. A blanket must then be thrown over the sheet 
and the pack left undisturbed for ten minutes. Then lift 
the child out quickly and envelop him in a warm blanket 
and allow him to remain at rest for some little time. 

In the absence of the physician, sponging with water, at 
a temperature of yo° or 8o°, is the only safe bath to employ 
to reduce temperature. In giving this bath, strip the child 
and place him in bed between blankets, while the nurse, 
inserting her hand between, must pass a damp sponge slowly 
over the surface. Five to ten minutes may be consumed 
in this operation, though, if the child complain of chilliness, 
discontinue the sponging at once ; a sensation of cold, too, 
indicates the use of warmer water. The operation may be 
repeated several times daily, or as often as every two hours 



IIO HYGIENE OF THE NURSERY. 

in urgent cases, and when the heat reduction is of short 
duration. 

The hot bath, 95 ° to ioo°, is employed for various pur- 
poses — to relieve nervous irritability, to promote sleep, to 
produce sweating, and to draw the blood to the surface in 
the event of congestion of some internal organ. Whether 
a full bath' or merely a foot bath be required, five minutes 
is sufficient time for immersion ; then, with or without dry- 
ing, according to the degree of sweating desired, the whole 
body, or only the feet and legs in case of a foot bath, must 
be enveloped in a blanket, and the child put to bed. To 
render these baths more stimulating, a teaspoonful to a 
tablespoonful of mustard flour may be added, and the child 
held in the water until the arms of the nurse begin to tingle. 
The hot bath is purely stimulating, and it is important not 
to continue it too long, lest the primary and only desirable 
effect be followed by depression. 

The blanket bath is useful in producing perspiration. 
Wring a blanket out of hot water and wrap it around the 
child ; then throw three or four dry blankets over him and 
leave him for half an hour ; rub the body then with a soft 
towel, to absorb the moisture thoroughly, and keep the 
child in bed. 

There are several medicated baths in frequent domestic 
use, which it may be useful to describe. 

Mustard Bath. — Take from two teaspoonfuls to two table- 
spoonfuls of mustard flour ; hot water, two to four gallons. 

In form of foot bath it produces sweating and determines 
the blood to the surface. As a general bath it acts as a 
powerful stimulant. 

Salt-water Bath. — Take four tablespoonfuls of rock salt, 
or Ditman's sea salt, or concentrated sea water ; water, hot 
or cool, according to season, four gallons. 



BATHING. Ill 

To be used as a general bath every morning in chronic 
tuberculosis, scrofula, rickets, and general debility. Bath to 
be followed by thorough .rubbing of the surface, especially 
over the spine. 

Bran Bath. — Take one pint of bran ; tie up in a muslin 
bag, place in a quart of water, boil for an hour, squeeze bag 
thoroughly into the water, and add to four gallons of warm 
water. 

Useful in eczema and other skin diseases. 

Soda Bath. — Take one tablespoonful of bicarbonate of 
sodium; warm water, four gallons. 

Used in skin affections. 

Compresses are often useful. The wet compress consists 
simply of a roll of flannel or soft linen dipped in cold water 
and wrungout, and then applied to the part indicated. Cover 
this with a piece of oiled silk rather larger than the com- 
press. 

There are several matters thatbear a more or less close rela- 
tion to the subject of bathing. These are the care of the teeth, 
nails and hair. 

The teeth must be cleaned morning and evening, and the 
cleansing process must be begun with the appearance of the 
first tooth. Ordinarily, a soft wash rag folded over the fore- 
finger, dipped in cool water and thoroughly rubbed over 
the teeth, is sufficient to keep the early teeth clean, and 
does not injure the tender gums. Should a dark-colored 
scum form at the junction of the tooth and gum, a little pre- 
pared chalk or other bland tooth-powder may be used in 
addition. If it be impossible to get at the point of dis- 
coloration in this way, shape with a penknife a moderately 
hard bit of wood into the form shown in Fig. 14, then 
either bite or rub the woody fibres at the extreme end 
into a sort of bunch, wet this, dip it in the tooth-powder 



STICK FOR 
CLEANING 
TEETH. 



I 1 2 HYGIENE OF THE NURSERY. 

and gently rub at the discoloration until it disappears, 
taking care not to make the gum bleed. Over a piece of 
wood so shaped one may also wrap a bit of soft 
cambric and use water and powder as before. 

Take good care of the milk teeth, for if they 
become decayed and broken off or lost, their per- 
manent substitutes are apt to come in irregularly 
and produce a lasting deformity. 

The tooth brush can be used after a number of 
the milk teeth have been cut. The bristles should 
be very soft and fine, and it must be employed 
with gentleness. Unless there be some discolora- 
tion, no powder need be used. 
The child should early learn to clean his own teeth. 
The importance of taking care of the toe nails has already 
been referred to in the chapter on clothing. The finger 
nails should not be allowed to grow too long ; at the same 
time it is a bad plan to cut them close to the quick. In 
trimming them, use a moderately dull pair of scissors, and 
do not round them too much. When hang-nails appear, 
they must be cut close with sharp scissors. The fingers 
and toes should be inspected carefully after each bath, to 
see if they require attention. 

Directions have already been given in regard to washing 
the hair. All that remains to be said now is to repeat the 
caution against the use of a fine comb, and to protest 
against the employment of hair-oil and hair-washes. The 
best scent for the hair is an occasional dressing of soap and 
water; the best beautifier, a thoroughly good brushing with 
two good hair brushes, and the latter should be employed 
every morning and evening. 

Besides keeping the long hair of a girl free from scent and 



BATHING. 113 

grease, do not dress it over the ears or tie it up tight and 
make it " like a cap of iron over the skull." 

If the hair be well brushed and the scalp thus sufficiently 
stimulated, there will be enough natural oil secreted to keep 
it tidy ; artificial oily applications only act temporarily, and 
by blocking up the pores of the skin tend to make the hair 
drier and harder to keep in order. 

Should there be a tendency for the hair to fall out, wash 
the scalp thoroughly and frequently with soap and water 
and stimulate it by firm brushing and the use of a wash 
such as the following : — 

Je. Spt. ammon. aromat f^j. 

Tr. cantharidis f 3 iss. 

Glycerime f^ ss - 

Aq.rosae f^vij. M. 

A tablespoonful of this may be rubbed into the scalp once 
every day, the rubbing to be followed by washing with a 
sponge and vigorous brushing. 

In such cases, however, it is best to seek the advice of a 
physician, for falling out of the hair may be due to a variety 
of causes. 



114 HYGIENE OF THE NURSERY. 



CHAPTER VIII 

FOOD. 



The choice of food and the method of feeding bear so 
close a relation to age that it is necessary, in studying these 
questions, to regard them from the standpoint of the two 
stages of a child's life mentioned in the first chapter ; that 
is to say, the periods of infancy and childhood. 

Infancy. — An infant may be fed in one of three ways: 
ist, from the mother's breast; 2d, from the breast of a 
foster mother or wet-nurse ; and 3d, from a bottle, by the 
method known as artificial or hand-feeding. 

1 st. Feeding from the maternal breast. There can be no 
doubt that this, being the natural, is at the same time the 
proper method of nourishing the human infant ; and fortu- 
nate is the babe that, in our day of advanced civilization 
and city-living, can draw from the breast of a robust mother 
an abundant supply of pure, health-giving, tissue-building 
food. 

It follows, therefore, that every woman who is free from 
certain contra-indicating diseases, to be mentioned later, 
should nourish her child solely from her breast up to the 
age of eight months, and partially to the end of the first 
year, or, failing in either limit, so long as possible. 

The infant should be put to the breast as soon as the 
mother has recovered somewhat from the fatigue of labor- 
some four or eight hours after birth. Of course no milk 
can be drawn at this early date, but the babe gets a small 
quantity of thin, watery fluid, called colostrum, which 
affords sufficient nourishment, and at the same time, from 






FOOD. 115 

its laxative properties, cleans the bowels of the greenish or 
black, viscid material that collects in the infant's bowels during 
intra-uterine life. This procedure, too, is of great advantage 
to the mother, for it insures proper contraction of the womb, 
draws out the nipples and encourages the formation of 
milk. 

As the secretion of milk is never fully established until 
the third day after labor, it stands to reason that no food 
other than the colostrum is required before, that time. 
Hence, the practice of filling the infant's stomach with 
gruel, sugar and water, and other sweetened mixtures, is 
more than useless, for it diminishes the activity of sucking 
and the consequent stimulation of milk production. Put 
the child to the breast every two hours while the mother is 
awake, and there need be no fear of starvation. 

After the third day, should the breasts not yield a supply 
of milk, a little sound cow's milk diluted with double its 
quantity of water and sweetened with sugar of milk, may 
be given every fourth hour, the babe being put to the breast 
in the meanwhile. So soon as the flow begins, however, 
this artificial feeding is to be discontinued. 

Usually on the fourth day milk is secreted and regular 
lactation commences. Many untrained mothers make a 
failure of nursing because they know nothing of the manner 
of giving suck ; of the length of time the child should be 
kept at the breast ; of the proper time for, and interval 
between, feeding, and of the importance of regularity. Upon 
these points the physician must be able, if required, to give 
minute instructions. 

When giving the breast, the infant must be held partly 
on its side, on the right or left arm, according to the gland 
about to be drawn, while the mother must bend her body 
forward so that the nipple may fall easily into the child's 



I l6 HYGIENE OF THE NURSERY. 

mouth, and steady the breast with the first and second 
finger of the disengaged hand, placed above and below the 
nipple. In case the milk run too freely — a condition very 
apt to excite vomiting — the flow is easily regulated by gentle 
pressure with the supporting fingers. Each of the breasts 
should be drawn alternately, the contents of one being suffi- 
cient for a meal ; and a healthy child may be allowed to 
nurse until satisfied, when he will stop of his own accord, 
drop the nipple and fall asleep with milk still flowing over 
his lips. 

During the first six weeks the breast is required every 
second hour, from 5 a.m. until 1 1 p.m. At night the infant 
should be put in a crib by the mother's bed, or, better still, 
in the nurse's room, and there remain quietly until the 
morning feeding. This secures the mother six hours of 
uninterrupted repose, a matter of great importance to her 
general health and consequent capacity for prolonged lacta- 
tion. As to the infant, he may rebel at first, and wake and 
cry, so that it is necessary to quiet him with a little milk 
and water administered from a bottle ; but often after a few 
days, and certainly at the end of a week or two, the good 
custom of sleeping at night is formed, and there is no further 
trouble. 

Regularity in meal hours is even of more importance in 
early than in adult life, on account of the natural feebleness 
of digestion. To secure this, it is only necessary to have a 
little perseverance, for infants are such creatures of habit 
that a short training brings them into the way of expecting 
food only at certain times, and, when healthy, they wake to 
suck the breast with almost the precision of the clock. 
While insisting upon this rule, one must recognize the fact 
that, although in the vast majority of instances a two-hours' 
interval is most suitable up to the second month, there is no 



FOOD. 117 

absolute law as to the number of daily nursings. Some 
infants seem to need food less frequently, and it is best to 
respect their peculiarity -and not force the breast upon them 
so long as they sleep well, do not fret when awake, and 
thrive generally. Others, again, may require it oftener, 
every hour and a half, perhaps, and once or twice at night. 
In these exceptional cases an appropriate schedule can only 
be made by close observation of individual characteristics. 

A common and most ruinous mistake is to resort to 
constant feeding as a means of pacifying crying. Babies 
certainly do cry from hunger, but just as frequently the 
crying results from colic, or from the discomfort and pain 
of indigestion. Every mother should be able to recognize 
the difference. The cry from hunger usually begins after a 
sound sleep, is not peevish, and stops at the sight of the 
breast, when the infant rouses himself, presents an expression 
of pleasure, clinches his hands and flexes his limbs. The 
cry of colic is violent and paroxysmal ; the face is livid and 
wears an expression of suffering ; the abdomen is distended 
and hard; the hands and feet are cold; the legs are drawn 
up or kicked violently about ; and an explosion of wind 
from the mouth or bowels ends the attack. A peevish cry, 
hot skin and sour breath attend indigestion. 

It stands without saying that the cry of hunger must be 
relieved by giving food ; but this is the very worst thing to 
do under other circumstances, for it both breaks up good 
habits and produces serious mischief. The pain of colic and 
the discomfort of indigestion are chiefly due to the accumu- 
lation of flatus resulting from the fermentation of food. 
Mothers soon learn, and unfortunately infants too, that the 
breast-milk temporarily relieves suffering. This it does in 
the same way as any other warm liquid ; but, unlike a 
simple fluid, milk only adds more material to the already 



Il8 HYGIENE OF THE NURSERY. 

fermenting contents of the gastro-intestinal canal, and every 
nursing is soon followed by more pain, until between crying 
and sucking and sucking and crying the infant's life is passed 
in misery, if not cut short altogether. Instead of continu- 
ous feeding, the plan for relief is to decrease the quantity 
of food by increasing the intervals between nursing and by 
abridging the time of lying at the breast, while medicines 
are employed to strike at the root of the evil. 

After the sixth week the interval between nursings may 
be slowly increased until, by the fourth month, it reaches 
three hours. During this period, also, the time of lying at 
the breast may be gradually lengthened, for the quantity of 
milk secreted and the child's appetite and capacity for food 
are all augmented as the days pass by. At the end of the 
sixth month, feeding every fourth hour suits some children 
well, but as a rule the three-hour interval must be adhered 
to from the fourth month to the end of lactation. 

Many authorities recommend additional artificial feeding, 
alternating with nursing, after the sixth or eighth month. 
Such a plan is perfectly proper, if the babe cease to gain 
strength and flesh while on the breast. If otherwise, the 
maxim of not interfering with any course that is doing well 
is as applicable here as elsewhere, and the breast may be 
relied upon entirely until the time comes for weaning. 

Should additional nutriment be required, the food must 
be selected with due reference to age and prepared in the 
same manner as in regular hand-feeding. 

The date of weaning cannot be exactly fixed for all cases, 
since it must depend upon two conditions, — the health of 
the mother and the development of the child. When the 
former continues to be robust and the child steadily grows 
and gains flesh, lactation can be prolonged until the tenth 
or twelfth month. If persevered in longer, the mother's 



FOOD. II9 

strength begins to fail, her milk is lessened in quantity or 
becomes poor in quality, the child's nutrition suffers, and 
he grows pale, thin and ilabby, and may develop the disease 
known as rickets. 

Change in the manner of feeding may be accomplished 
gradually or suddenly. In gradual weaning, about four weeks 
are required to prepare for the absolute withdrawal of the 
breast. For instance, if suck be given every three hours, 
from 5 a. m. until up. m., or seven times a day, there should 
be, during the first week of preparation, one artificial feeding 
and six nursings daily ; during the second, two and five ; 
during the third, four and three ; during the fourth, six and 
one. Then the breast must be entirely withheld. Carefully 
prepared milk-food, administered from a bottle, is the best 
substitute. At the age of ten months a mixture that ordi- 
narily agrees well is : — 

R. Cream 1 tablespoonful. 

Milk 8 tablespoonfuls. 

Sugar of milk I teaspoonful. 

Water 3 tablespoonfuls. 

This is to be poured into a perfectly clean bottle, warmed 
in a water bath, and taken through a clean, plain rubber 
tip. Should the quantity (six fluidounces*) be insufficient 
to satisfy the child's appetite, all the ingredients except the 
cream may be increased until the mixture measures eight or 
even twelve fluidounces, according to the demand. 

When such accidents as fever, disordered digestion, with 
vomiting and diarrhoea, or the actual cutting of one or more 
teeth occur during the period of preparation, the number of 
artificial feedings must be reduced, or the breast resumed 

* One fluidounce = two tablespoonfuls. 
One fiuidrachm = one teaspoonful. 



120 HYGIENE OF THE NURSERY. 

until the disturbance be passed ; then the course may be 
begun again and carried to its completion. 

Usually there is little trouble in weaning infants in this 
way. Sometimes they become fretful under the change and 
may refuse food entirely for a day or more ; but a little 
determination on the part of the mother and the cravings 
of hunger will soon overcome this difficulty. 

Occasionally the child refuses to suck milk from a bottle 
or to drink it from a cup or spoon, in fact seems to object 
to any form of liquid food except that drawn from the 
mother, while at the same time he is eager for bread or 
other solid food. Under these circumstances prepare for 
each meal a moderate portion of either rice pudding or 
junket, both, of course, milk foods. After these have been 
taken for a day or two, add to each meal a little milk, reduc • 
ing the amount of pudding or junket ; stir the whole together 
and feed from a spoon ; next day still further reduce the 
solid and increase the liquid, and so proceed until finally a 
taste for milk is cultivated. 

Sudden weaning is not advisable unless, while the breast 
is being presented, there is an absolute refusal to take artifi- 
cial food from either a bottle or a spoon. This is most apt 
to occur when food has been given too frequently, and when 
the breast has been used as a means to quiet crying. The 
plan is also to be recommended when the mother's health 
becomes so affected as to render any further sucking a 
positive peril to the child's life; rapidly developing tuber- 
culosis of the lungs and attacks of erysipelas or of smallpox 
are instances in point. 

The physician is often forced to decide upon the advisa- 
bility of premature weaning. His decision must be made 
cautiously and after thorough investigation of two proposi- 
tions, namely, «, the effect of further lactation upon the 



FOOD. 121 

health of the mother, and b, the requirements of the 
child. 

a. Lactation being a physiological process is not a drain 
upon the systemic strength so long as the functions of 
nutrition are actively performed, but under other circum- 
stances it very frequently becomes so. Consequently, 
premature weaning is necessary when the mother is attacked 
by any acute disease threatening dangerous temporary 
prostration, such as typhoid or typhus fever. A change 
must also be made if pulmonary tuberculosis be developed, 
or, being already present, rapidly advances under the drain 
of milk secretion. Ordinarily, however, the general con- 
dition that leads to withdrawal of the breasts is one of 
simple loss of strength and flesh on the part of the mother. 

Undoubtedly these indications often warrant the proce- 
dure, but every one who has seen much of children's prac- 
tice must have met with many cases in which the advice to 
wean has been given carelessly and unnecessarily, and in 
which the child might have had its natural food had proper 
attention been given to the health of the mother. 

If a woman be worn out by household cares, if she wear 
herself out by a round of dinners, balls or shopping, or if 
she expose herself to injurious atmospheric conditions and 
eats improper food, she grows weak and thin whether she 
be nursing or not ; and a woman heedless of her health will 
probably care little whether she suckles her child or gives 
it up to a wet-nurse or to the bottle. 

In addition to making nursing the important duty of her 
life for the time being, a mother must be as free from house- 
keeping cares as possible. Mental and physical fatigue is 
to be avoided, sufficient exercise must be taken to main- 
tain a healthy appetite and digestion, and abundant time 
devoted to rest and sleep. Beyond securing a plentiful 



122 HYGIENE OF THE NURSERY. 

supply of plain and easily digestible food, with a judicious 
portion of meat, vegetables, and fruit, it is unnecessary to 
give special attention to the diet. 

Should the secretion of milk be scanty, it may often be 
increased by the free use of animal broths, chocolate, gruel, 
or milk, and sometimes the moderate employment of stimu- 
lants, in the form of ale and porter, may be necessary. 
Such tonics as malt extract, ferrated elixir of cinchona, 
bitter wine of iron, and the preparation known as " beef, 
wine and iron," are useful when there is anaemia, or when 
the general failure of strength cannot be overcome by food 
and attention to hygienic rules. 

The ordinary local conditions indicating premature wean- 
ing, on the mother's account, are fissures of the nipple and 
mammary abscess. 

Fissure being usually a unilateral condition, it is only 
necessary to retire the affected side from duty and nourish 
the child alternately from the unaffected gland and from 
the bottle until healing takes place, the disabled breast 
being pumped in the meantime to keep up secretory activity. 
Should both sides be affected, weaning may be imperative, 
on account of the extreme pain produced by sucking, 
though, even under these circumstances, an effort must be 
made to maintain the flow of milk by regular pumping. 
Sometimes women are able to struggle through the attack 
by taking advantage of the relief and protection afforded 
by a nipple-shield. 

Fissures of the nipple are preceded by abrasion, excoria- 
tion or erosion having origin in erythema, eczema or ecchy- 
mosis. They result, also, from want of cleanliness or from 
keeping the nipple too moist, as when constant sucking is 
allowed or when there is a continual flow of milk. They 
may be prevented by proper attention to the nipple before 



FOOD. 123 

confinement. During the latter months of pregnancy the 
clothing covering the breast must be loose, and the wearing 
of a wire tea-strainer over the nipple to prevent pressure has 
been recommended by one authority. Each day, for three 
months before labor, the nipples should be washed thoroughly 
with hot water in the morning and anointed with cocoa-butter 
in the evening. At the same time, should the nipples be 
small or retracted, the woman must be taught to use her 
thumb and finger to draw them out. This process is not 
only an advantage in giving proper size and shape, but 
brings the skin into good condition without hardening it. 
The application of alcoholic and astringent solutions are not 
to be recommended, as they tend to harden the tissue, which 
should be soft and pliable rather than tanned, this rendering 
them liable to crack. 

When a fissure exists, it is best first to see whether or 
not nursing can be continued by means of a nipple-shield. 
Should the child refuse this, a good plan is to fill the shield 
with warm milk and invert it over the nipple. The infant 
then draws the fluid at once and without difficulty, and will 
often continue sucking so that the breast milk follows. 
After nursing and removing the shield, the nipple must be 
dried thoroughly with absorbent cotton, and the following 
lotion applied with a camel's-hair brush : — 

R. Acid, boracic. gr. xx. 

Mucilag. acaci?e f ^j. 

b. On the part of the infant, there are several indications 
for anticipating the time of withdrawing the mother's breast. 
It must be done if the occurrence of pregnancy or the 
recurrence of menstruation render the milk unwholesome ; 
if the mother contract a dangerous contagious disease, as 
smallpox, scarlet fever, or erysipelas ; if the mammary glands 



124 HYGIENE OF THE NURSERY. 

become inflamed ; if the breast does not afford sufficient 
nourishment and artificial food be refused ; and, finally, if 
dentition be markedly delayed and the premonitory symp- 
toms of rickets appear. As to the amount of nourishment, 
it must be remembered that the breast milk may be of good 
quality, but so diminished in quantity that it is insufficient ; 
or, while abundant in quantity, so poor in quality that it 
does not meet the demands of nutrition. Even without a 
minute examination of the milk, it is possible to form a good 
idea of which condition is present from the behavior of the 
infant in the act of sucking. If the milk be good in quality 
but deficient in quantity, the babe, when put to the breast, 
seizes the nipple as if famished and draws upon it vigor- 
ously for a moment or two, and then drops it with a scream 
of rage. On the contrary, should there be an abundant 
supply of the poor milk, the nipple is grasped languidly, 
the child lies a long time at the breast and falls asleep there. 
Consideration of the final indication opens the question of 
the propriety of regulating weaning by the progress of 
dentition. This is certainly a good guide, but not in the 
way implied in the old precept, that the child must not be 
taken from the breast until evolution of the stomach and eye 
teeth. Insufficient food is one of the chief causes of rickets, 
and rickets more than any other disease delays dentition ; 
consequently, should the teeth not pierce the gum in time, 
the inference is for other food rather than a continuance of 
the faulty maternal supply. 

Upon deciding to anticipate the time of weaning, the next 
point to consider is whether the infant shall be brought up 
by hand or by a wet-nurse. 

2d. Feeding by a wet-nurse. The advantage of feeding 
from the breast of a wet-nurse is that the mother's milk is 
substituted by the milk of another woman ; in other words, 



FOOD. 125 

that natural feeding is continued — a matter of moment in all 
cases and of inestimable importance with delicate children. 
The disadvantage consists in the difficulty of finding, in a 
woman belonging to the class from which wet-nurses come, 
all the moral and physical characters essential to a good sub- 
stitute, and the fact that a stranger is introduced into the 
household, often to deceive and annoy the family and on the 
slightest provocation to leave her charge to fate or to the 
tender mercies of another of her kind. For these reasons 
it is preferable, in the majority of instances, to trust to care- 
ful bottle-feeding. Nevertheless, as some children must have 
human milk if their lives are to be saved, the rules for select- 
ing a wet-nurse must be understood. 

The woman chosen must be strong and robust, but rather 
spare than fat. Her bill of health must be perfectly free 
from hereditary tendency to mental or physical disease and 
from taint of syphilis, consumption or scrofula. She must 
be cheerful, good-natured, active, careful, and temperate in 
habits. Her age should be between twenty and thirty years ; 
she should understand the care of an infant and the manner 
of giving suck ; her child ought to be nearly the same age 
as the infant to be adopted, and she must be able to afford 
an abundant supply of good milk. 

The last quality can be estimated by inspecting the breasts, 
by examining some of the milk drawn by a pump, and by 
ascertaining the condition of the woman's own child. The 
breasts of a good nurse are not necessarily large, but are 
firm to the touch and pyriform in shape, with well-developed, 
prominent nipples, and with the skin distinctly marbled with 
large blue veins. The milk, which ought to flow readily 
on pressure or on suction, should be opaque and dull white 
in color, have a specific gravity of 1.031, an alkaline reaction, 
and show, when placed under the microscope, a number of 



126 HYGIENE OF THE NURSERY. 

minute, equal-sized, fat globules. Its quantity may be 
ascertained by weighing the child before and after sucking, 
the normal gain being from three to six ounces. There is, 
however, no better or more readily applied test of the qual- 
ity of a nurse than the size, weight, and general develop- 
ment of her child ; and if it be weak and ill-nourished, no 
amount of fitness in other respects can warrant her engage- 
ment. 

Even when a woman be found fulfilling in her single 
person all of the above conditions — a rare event, indeed — it 
does not necessarily follow that her milk will suit the babe 
to be suckled. Then changes and new trials must be made 
until the desired end be attained. 

The diet of a wet-nurse and the manner of weaning, must 
be governed by the rules already given for maternal feeding. 

Few wet-nurses are employed in Philadelphia, for the 
simple reason that they are most unsatisfactory. Personally, 
I have had such good results from carefully regulated bottle- 
feeding, that I have almost given up the employment of 
wet-nurses, preferring to regulate the artificial food myself 
rather than allow an ignorant woman to supplement sub rosa 
her deficient supply of breast milk by an unskillfully pro- 
portioned food, — an event of not uncommon occurrence. 

3d. Artificial feeding. In my experience, there are few 
American women, especially in the well-to-do classes, who 
do not look upon the duty of nursing their babies as a 
pleasant one ; but there are many who are completely 
unable to do so, and a vast number in whom the secretion 
of milk fails after a few weeks or months of lactation. 
They must, through no fault of their own, resort to a wet- 
nurse or to artificial feeding. Usually, they select the last 
method, with results that vary in direct proportion to the 
care and intelligence displayed in carrying it out. 



FOOD. 127 

There can be no doubt, though the statement is a bold 
one and seemingly contrary to nature, that, taking the 
average, infants properly brought up by hand are better 
developed and enjoy more perfect health than those com- 
pletely breast-fed. Of course there is no artificial food 
equal to the natural — the sound breast milk of a robust 
woman — and a child fed upon this must thrive, if other cir- 
cumstances be favorable. Unfortunately, the woman who 
has sufficient health and strength to furnish an abundant 
supply of good milk during the ten or twelve months of 
normal lactation is unique in our large cities ; and the great 
bulk of those who do nurse children grow pale, thin and 
feeble, and give milk which, though sufficient in quantity 
to fill the suckling's stomach and satisfy the cravings of 
hunger, does not contain enough pabulum to meet the 
demands of nutrition. Such mothers always complain that 
their children are puny, peevish and always ailing, and 
wonder why their neighbor's babies, fed upon the bottle, 
are so round, jolly and healthy. The explanation lies in 
the simple fact that good cows' milk is better than bad 
breast milk. 

Infants can be reared perfectly well upon the bottle, but 
much more care and trouble are involved than in breast feed- 
ing. The task is comparatively easy to accomplish when the 
powers of digestion are inherently active, and especially 
when artificial feeding is not required until after the child 
has been suckled for several weeks. In these cases the 
stomach and intestinal canal, inactive in fcetal life, are trained 
to their new duties under normal conditions, and so pre- 
pared for the digestion of properly selected artificial food. 
On the contrary, if digestion be naturally feeble, or if the 
infant must be bottle-fed from the first, great difficulty may 
be expected, and most skillful handling is necessary. 



128 HYGIENE OF THE NURSERY. 

To insure success in hand-feeding, it must be remem- 
bered that an infant is not nourished alone by the food he 
swallows, but by that portion of it he digests and assimi- 
lates. The best diet, therefore, is one so adapted to age 
and digestive power that everything eaten will be digested 
and absorbed. But as children differ as much in constitu- 
tion as in feature, it is impossible to formulate exactly a food 
that will be applicable to every case, or one that needs no 
change from month to month of progressing growth. As 
age and strength increase, there is a corresponding devel- 
opment of the gastro-intestinal functions and a call for 
more and stronger food. On the other hand, should the 
system be accidentally reduced by disease, the digestion, 
sympathizing in the general debility, temporarily loses its 
normal activity and assumes that of an earlier age. Now, 
more nourishment is certainly needed to build up the failing 
strength, but it is to be supplied by giving such food as can 
be completely assimilated, and not by forcing down strong 
food merely because it is strong ; for the latter, when not 
vomited, passes through the bowels undigested, and the 
little creature starves to death in the midst of plenty, or 
dies from the ill effects of the constant presence of ferment- 
ing food in the alimentary canal. On these accounts many 
changes in diet as to quality and quantity must be antici- 
pated and made. 

Other important matters to be studied in detail are : a, 
the selection of a proper substitute for the breast milk ; b, 
the quantity to be given ; c, the method of preparation ; d, 
the mode of administration ; and e, the means of preservation. 

a. Healthy breast milk must be taken as the type of 
infants' food, and the nearer an artificial substance can be 
made to approach it in chemical composition and physical 
properties, the more perfect is it. 



FOOD. 129 

Normal breast milk has a specific gravity of 1.031. It 
is a persistently alkaline fluid, having a somewhat animal, 
usually disagreeable, and very rarely sweetish taste. It is 
bluish-white in color and thin and watery in consistence. 

According to Leeds' very thorough analysis, it contains : — 

Water 86.766 per cent. 

Total solids 13-234 " 

Total solids not fat 9.221 " 

Fat 4- OI 3 " 

Milk sugar 6.997 " 

Albuminoids 2.058 " 

Ash 0.21 " 

It contains, then, nitrogenous material, carbohydrates, 
salts and water — all the elements essential to repair tissue 
waste, to supply new material for growth and to maintain 
body heat, or, in other words, to constitute a perfect aliment; 
and these, too, are so proportioned in the combination as to 
most easily and completely meet the demands. 

It must not be supposed, however, that the elements are 
uniformly present in the same proportion. On the contrary, 
the fluid varies both at different periods of lactation and in 
different individuals. 

This fact is the most striking feature of the above observ- 
er's work, which shows that the most changeable constituent 
is the albumen, varying from a maximum of 4.86 per cent, 
to a minimum of 0.85 ; the next are the fats and salts, the 
maximum being about three times the minimum, and the 
least the sugar. The latter, in fact, varies but little from a 
standard of about 7 per cent. The function of albumen is 
nutritive, that of milk sugar calorifacient ; hence the point 
seems to be that nature, while allowing a wide range of 
oscillation in the rapidity of tissue building, carefully pro- 
vides an available fuel for the constant maintenance of 
9 



130 HYGIENE OF THE NURSERY. 

animal heat; the supply of caloric due to cerebral impulses 
and self-originated locomotion being extremely small in 
early infancy. 

In seeking a substitute for human milk, one naturally 
turns to the domestic animals for the source of supply. 
Between the milk of the ass, cow, goat and ewe there is little 
choice, so far as composition is concerned, though, perhaps, 
asses' milk resembles that of women a little more closely 
than the others; nevertheless, cows' milk is usually selected, 
because, being plentiful, it is easily obtained and cheap. 

Cows' milk* (market milk) has a specific gravity of 1.029, 
is richer looking — that is, whiter and more opaque than 
human milk, and is slightly acid in reaction unless perfectly 
fresh from pasture-fed animals, when it may be neutral or 
alkaline, and contains — 

Water 87.7 per cent. 

Total solids 12.3 " 

Total solids not fat 848 " 

Fat 3.75 

Milk sugar 4.42 " 

Albuminoids 3.42 " 

Ash 0.64 « 

Comparing this analysis with that previously given, it is 
readily seen that the two fluids differ in specific gravity and 

* The characters of cows' milk may be determined with sufficient accuracy 
in the following way: — 

Provide a urinometer, such as shown in the accompanying cut, and which 
can be obtained at any drug shop. To obtain the specific gravity, fill the 
beaker to such a point with milk that it will float the specific gravity glass, and 
read the degree of density from the scale at a level with the surface of the 
milk. The chemical reaction is found by inserting a piece of blue litmus 
paper, which should turn slightly red a few moments after being wet. To 
ascertain the proportion of cream, cut a narrow strip of paper four inches long, 
and divide the upper half-inch, by cross-markings, into twelve equal parts; 



FOOD. 



131 



reaction, and that cows' milk contains more nitrogenous ma- 
terial, but less fat and much less sugar than woman's milk. 



Fig. 15. 




LACTOMETER. 



paste this on the beaker with the marked portion uppermost, and the lower 
edge coming accurately to the bottom of the glass (see Fig. 15) ; then pour in 
enough milk to come just to the top of the paper, and place the whole aside for 
twenty- four hours. During this time the cream rises and appears as a yellow 
layer at the top; this layer should have the depth of ten or twelve spaces. 



132 HYGIENE OF THE NURSERY. 

The nitrogenous material diners in quality as well as in 
quantity. Konig, in a number of analyses that closely cor- 
respond with those of Leeds, divides the nitrogenous 
constituent into three groups ; namely, caseine, albumen 
and albuminoids, basing the division upon the different 
effects of coagulating agents. 

Upon this point Leeds remarks : " Whilst by present 
modes of analysis the separation of the so-called caseine 
from the so-called albumen is not accurately performed, yet 
the results are approximately correct (Konig's), and have a 
very great value in pointing out the most important of all 
the differences between the two secretions, which is, that 
the fraction of the total albuminoids in cows' milk which is 
coagulable by acids is far greater (perhaps four times) than 
the non-coagulable part. 

" In woman's milk, on the contrary, the reverse is true, 
and the non-coagulable part much exceeds (perhaps by 
more than twice) the coagulable portion." 

This difference is readily tested by adding rennet to the 
two fluids. In the case of cows' milk the caseine is coagu- 
lated into large, firm masses, while with human milk a light, 
loose curd is formed. In the stomach the acid gastric 
juice has the same effect, producing in the first instance a 
coagulum most difficult to digest; in the other, one readily 
attacked and broken down by the gastro-intestinal solvents. 

These chemical and physical properties of cows' milk 
can be altered by various methods of preparation, and 
unless this be done there are few instances in which it will 
not prove a poor substitute for the natural food. 

Condensed milk is frequently recommended by physi- 
cians and largely used by the laity, on their own re- 
sponsibility. It keeps better than cows' milk and is 
supposed to be more readily digested by young infants. 



FOOD. 133 

The latter supposition is a mistaken one, and arises from 
the overlooked fact that condensed milk is always given 
dissolved in a large proportion of water, while cows' milk 
is too frequently used insufficiently diluted or otherwise im- 
properly prepared. The author is convinced of the accuracy 
of this statement from a number of years' close study of the 
subject. 

Condensed milk contains a large proportion of sugar, 
forms fat quickly, and thus makes large babies ; sugar also 
counteracts the tendency to constipation — often a trouble- 
some complaint in hand-feeding. These advantages are 
unquestioned, and, together with the ease of preparation, 
are those which place it so high in the esteem of monthly 
nurses. It is equally true that, as a food, it does not con- 
tain enough nutrient material to supply the wants of a 
growing baby. 

Again, more than half of the saccharine ingredient of 
this preparation is cane sugar, added for the purpose of 
preservation, and this material is very liable, when in excess, 
to ferment in the alimentary canal, giving rise to irritant 
products that impede digestion. 

Infants fed upon condensed milk, though fat, are pale, 
lethargic and flabby ; although large, are far from strong ; 
have little power to resist diseases ; cut their teeth late, and 
are very likely to drift into rickets. It must be remembered 
also that condensed milk, when long kept, or when packed 
in imperfect cans, not unfrequently undergoes decomposi- 
tion, and thus becomes utterly unfit for use. 

For a temporary change of diet, and as a substitute during 
traveling or under circumstances in which sound cows' milk 
cannot be obtained, it may be resorted to with advantage. 

The farinaceous substances so often selected, especially by 
the poor, to replace breast-milk, are not only bad foods, but 



134 HYGIENE OF THE NURSERY. 

have both directly and indirectly a deleterious effect upon 
the processes of nutrition. 

They are bad for two reasons. First, they differ ma- 
terially in chemical composition from human milk. For 
example, in arrowroot, which is the favorite, the proportion 
of the nitrogenous to the calorifacient element is as one to 
twenty, while in human milk it is about one to five. Secondly, 
the calorifacient principle, starch, must be converted into 
sugar before it can be absorbed. This change is accom- 
plished in the body by the saliva and pancreatic juice, — 
secretions that are not fully established until the fourth 
month. 

While the starch lies undigested in the gastro-intestinal 
canal, it is subject to fermentation, resulting in the formation 
of irritant products that rapidly induce catarrh of the mucous 
membrane, a condition directly interfering with the digestion 
and absorption of food. Again, perfect nutrition demands 
rapid waste and removal of effete tissues as well as repair of 
the same. This is effected by oxidation. Now sugars are 
known to have a much greater affinity for oxygen than 
albuminates, and when the diet consists of farinaceous mate- 
rial, the little sugar formed and absorbed appropriates oxygen 
that would otherwise go toward the removal of waste, and so 
retards the necessary changes. 

Farinaceous food, as such, is never permissible before the 
fourth month ; earlier, it is only to be employed for its 
mechanical action, as an addition to milk preparations. This 
will be mentioned later. 

The nutrient value of the cereals and their products as 
they exist in so-called " infants' foods," has been imperfectly 
determined. They are undoubtedly useful as mechanical 
attenuants, but it is very questionable whether any of them, 
unless prepared with milk, can permanently meet the 



FOOD. 135 

demands of nutrition. At the same time it is quite prob- 
able that the soluble albuminoid substances obtained by 
Liebig's process have a food value of their own, making 
them more serviceable than the starches. 

b. The quantity of food to be allowed each day varies 
with the appetite and age. Some infants habitually eat 
little, others much; as both thrive, the question of the cor- 
rect amount in a given case must be answered by observa- 
tion. So long as the child develops with normal rapidity 
and keeps well, he may be allowed to eat as much or as 
little as he wants; for, if food of proper strength be given 
at proper intervals, the instinctive cravings of hunger, since 
they represent the wants of the system, rarely lead to excess 
in either direction. Nevertheless it is well to have some 
guide. 

During the first four weeks, infants generally require 
from twelve and-a-half to sixteen fluidounces of food; in 
the second and third months, about twenty-four fluidounces, 
and from this time to the twelfth month from two to two 
and-a-half or even three pints. After the twelfth month 
the quantity depends upon whether additions be made to 
the diet, or milk food be used exclusively. When the daily 
amount reaches three pints, the limit of the capacity of the 
stomach is usually attained, and the greater demand for 
nutriment, as growth advances month by month, must be 
met by adding to the strength of the food rather than by 
increasing its bulk. These two factors, strength and quan- 
tity, are intimately associated throughout the whole period 
of infancy, and in the earlier months a mere increase in the 
latter is not always sufficient to maintain the balance of 
nutrition. 

As a rule, infants are overfed so far as quantity is con- 
cerned, and this opens the very interesting question of the 



136 



HYGIENE OF THE NURSERY. 



normal capacity of the stomach at different ages. Rotch 
has recently written an important paper upon the subject. 
He states that, by actual measurement, the stomach of an 
infant five days old holds 25 c.c, or six and-a-quarter 
fluidrachms, a quantity very far short of that usually forced 
upon the babe during the first week. Frowlowsky's inves- 
tigations show that there is a very rapid increase in the 
capacity of the stomach during the first two months of life, 
while in the third, fourth and fifth months the increase is 
slight. Guided by these data, the quantity of food should 
be rapidly augmented during the first six or eight weeks of 
life, and then held at the same quantity up to the fifth or 
six month. Another considerable increase is also de- 
manded between the sixth and the tenth months. 

While the author has been unable to verify the above 
measurements, and has, on the contrary, found no uni- 
formity in the size of the stomach for given ages, yet the 
following table (Rotch) is a useful one, and corresponds 
closely with conclusions drawn from clinical experience. 

GENERAL RULES FOR FEEDING. 



Age. 


Intervals of 
Feeding. 


Average Amount at 
Each Feeding. 


Average Amount in 
24 Hours. 


First week. 


2 hours. 


1 ounce. 


10 ounces. 


One to six weeks. 


2j^ hours. 


iy£ to 2 ounces. 


12 to 16 ounces. 


Six to twelve weeks 
and possibly to fifth 
or sixth month. 


3 hours. 


3 to 4 ounces. 


18 to 24 ounces. 


At six months. 


3 hours. 


6 ounces. 


36 ounces. 


At ten months. 


3 hours. 


8 ounces. 


40 ounces. 



FOOD. 137 

c. The object to be accomplished in the preparation of 
cows' milk is to make it resemble human milk as much as 
possible in chemical composition and physical properties. 
To do this, it is necessary to reduce the proportion of 
caseine, to increase the proportion of fat and sugar, and to 
overcome the tendency of the caseine to coagulate into 
large, firm masses upon entering the stomach. 

Dilution with water is all that need be done to reduce 
the amount of caseine to the proper level; but as this 
diminishes the already insufficient fat and sugar, it is essen- 
tial to add these materials to the mixture of milk and water. 
Fat is best added in the form of cream, and of the sugars, 
either pure white loaf sugar or sugar of milk may be used. 
The latter is greatly preferable, as it is little apt to ferment, 
and contains some of the salts of milk, which are of nutri- 
tive value. 

Firm clotting may be prevented by the addition of an 
alkali or a small quantity of some thickening substance, as 
barley water, gelatine, or one of the digestible prepared foods. 

Lime water is the alkali usually selected. It acts by par- 
tially neutralizing the acid of the gastric juice, so that the 
caseine is coagulated gradually and in small masses, or 
passes, in great part unchanged, into the intestine to be there 
digested by the alkaline secretions. As it contains only a 
half a grain of lime to the fluidounce, the desired result 
cannot be attained, unless at least a third part of the milk 
mixture be lime water. The quantity often used — one or 
two teaspoonfuls to the bottle of food — has no effect beyond 
neutralizing the natural acidity of the milk itself. When 
lime water is constantly employed, it becomes quite an item 
of expense if procured from the drug shop ; this outlay is 
unnecessary, for it can be made quite as well in the nursery. 
Take a piece of unslaked lime as large as a walnut, drop it 



I38 HYGIENE OF THE NURSERY. 

into two quarts of filtered water contained in an earthen 
vessel, stir thoroughly, allow to settle and use only from the 
top, replacing the water and stirring as consumed. 

Instead of lime water, two to four grains of , bicarbonate 
of sodium may be added to each bottle, or, better still, from 
five to fifteen drops of the saccharated solution of lime. 

This solution is made in the following way : — 

Take of — 

Slaked lime I ounce. 

Refined sugar, in powder 2 ounces. 

Distilled water 1 pint. 

Mix the lime and sugar by trituration in a mortar. Transfer the mixture to 
a bottle containing the water, and having closed this with a cork, shake 
it occasionally for a few hours. Finally, separate the clear solution with 
a siphon and keep it in a stoppered bottle. 

Thickening substances — attenuants — act purely mechan- 
ically by getting, as it were, between the particles of caseine 
during coagulation, preventing their running together and 
forming a large, compact mass. 

When an " infant's food " is used to act mechanically, care 
should be taken to select one in which the starch has been 
converted into dextrine and grape sugar by the process of 
manufacture. The articles known as " Mellin's Food " and 
" Horlick's Food " can be relied upon. One teaspoonful of 
either dissolved in a tablespoonful of hot water and added 
to each portion of food, makes a very easily digested mixture. 

For the successful management of children, the practi- 
tioner must not only be familiar with the theory of feeding, 
but must be able to write out precise directions for the pre- 
paration of the food. To this end a schedule of the diet 
of an infant from birth upward, with a sketch of the modi- 
fications that have to be made most frequently, will serve as 
a useful guide. 



FOOD. 139 

Diet during the first week : — 

Cream ► 2 teaspoonfuls. 

Whey 3 teaspoonfuls. 

Water (hot) 3 teaspoonfuls. 

Milk sugar }( teaspoonful. 

For each portion ; to be given every two hours from 5 A. m. to i i p. m., and 
in some cases once or twice at night, amounting to twelve fiuidounces of 
food per diem. 

Diet from the second to the sixth week : — 

Milk 1 tablespoonful. 

Cream 2 teaspoonfuls. 

Milk sugar ^ teaspoonful. 

Water 2 tablespoonfuls. 

For one portion; to be given every two hours from 5 A.M. to 11 p.m.; 
amounting to seventeen fiuidounces of food per diem. 

Diet from the sixth week to the end of the second 
month : — 

Milk 2^ tablespoonfuls. 

Cream I tablespoonful. 

Milk sugar y z teaspoonful. 

Water 2)/ 2 tablespoonfuls. 

For each portion; to be given every two hours, amounting to thirty fluid- 
ounces per diem. 

Diet from the beginning of the third month to the sixth 
month : — 

Milk 5 tablespoonfuls. 

Cream I tablespoonful. 

Milk sugar 1 teaspoonful. 

Water 2 tablespoonfuls. 

For each portion ; to be given every two and a half hours, or thirty-two 
fiuidounces per diem. 

Diet during the sixth month ; six meals daily from 6 or 
7 a.m. to 9 or 10 p. M. 



140 HYGIENE OF THE NURSERY. 

Morning and midday bottles each : — 

Milk 9 tablespoonfuls. 

Cream I tablespoonful. 

Mellin's Food I teaspoonful. 

Hot water 2 tablespoonfuls. 

Dissolve the Mellin's Food in the hot water and add, with stirring, to the 
previously mixed milk and cream. 

Other bottles each : — 

Milk 9 tablespoonfuls. 

Cream I tablespoonful. 

Milk sugar I teaspoonful. 

Water , 2 tablespoonfuls. 

This gives an equivalent of thirty-six fiuidounces of food in a day. 

In the seventh month the Mellin's Food may be increased 
to two teaspoonfuls and given three times daily. 

Throughout the eighth and ninth months five meals a day 
will be sufficient. 

First meal at 7 A. m.: — 

Milk 13 tablespoonfuls. 

Cream I tablespoonful. 

Milk sugar I teaspoonful. 

Water 2 tablespoonfuls. 

Second meal at 10.30 A. m. Milk, cream and water in the 
same proportion ; Mellin's Food, one tablespoonful. 

Third meal at 2 p. m. — Same as second. 

Fourth meal at 6 p. m. — Same as second. 

Fifth meal at 10 p.m. — Same as first. 

This gives forty fiuidounces of food per diem. 

Instead of Mellin's Food, a teaspoonful of " flour-ball " * 
may be added. 

* See Chap. ix. 



FOOD. 141 

Two meals of flour-ball daily — say the second and fourth — 
are all that can be digested. To prepare these, rub one 
teaspoonful of the powder with a tablespoonful of milk into 
a smooth paste, then add a second tablespoonful of milk, 
constantly rubbing until a cream-like mixture is obtained. 
This is poured into eight ounces of hot milk, stirring well, 
and is then ready for use. The other meals should be com- 
posed of milk, cream, sugar of milk and water, as already 
given. 

Mellin's Food and flour-ball may be substituted by oat- 
meal or barley, or any one of the infants' foods in which 
the starch has been converted, by Liebig's process, into 
dextrine and grape sugar. 

Diet for the tenth and eleventh months : — 

First meal, 7 a.m.: — 

Milk 17 tablespoon fuls. 

Cream 1 tablespoonful. 

Mellin's Food I tablespoonful. 

(Or flour ball or barley jelly) 2 teaspoonfuls. 

Water (Used only with Mellin's Food) 2 tablespoonfuls. 

Second meal, 10.30 a.m. — A breakfast-cupful of warm 
milk (eight fluidounces). 

Third meal, 2 p.m. — The yelk of an egg lightly boiled, 
with stale bread crumbs. 

Fourth meal, 6 p.m. — Same as first. 

Fifth meal, 10 p.m. — Same as second. 

On alternate days the third meal may consist of a tea- 
cupful (six fluidounces) of beef tea containing a few stale 
bread crumbs. 

A further variation can be made by occasionally using 
mutton, chicken or veal broth instead of beef tea.* 

* See Chap. ix. 



142 HYGIENE OF THE NURSERY. 

As much more difficulty is experienced in feeding infants 
during the first twelve months than during the second, it 
would be well to pause here to consider what had best be 
done in case the food described should disagree. 

If, after feeding, vomiting occur, with the expulsion of 
large, firm clots of caseine, the effect of adding lime water 
or barley water must be tried. 

For instance, at the age of six weeks make each bottle 
of:— 

Milk 2y 2 tablespoonfuls. 

Cream I tablespoonful. 

Milk sugar y z teaspoonful. 

Lime water 2.]/^ tablespoonfuls. 

Or of:— 

Milk 2.y z tablespoonfuls. 

Cream I tablespoonful. 

Milk sugar y 2 teaspoonful. 

Barley water 2,y 2 tablespoonfuls. 

Sometimes, particularly if there be diarrhoea, boiling 
makes the milk more digestible, and in this condition it 
may be used instead of fresh milk in either of the above 
mixtures. Condensed milk, too, can be employed tempo- 
rarily, making each portion of: — 

Condensed milk i teaspoonful. 

Cream I tablespoonful. 

Hot water 5 tablespoonfuls. 

Should further alteration be necessary, goats' or asses' 
milk may be substituted for cows' milk, the strong odor of 
the former and the laxative properties of the latter being 
removed by boiling. One ass is capable of nourishing three 
children for the first three months of life, two children for 
the fourth and fifth months, and one child after this period 



FOOD. I43 

to the ninth month. The milk should be used warm from 
the udder. 

" Strippings " is another good substitute for cows' milk. 
It is obtained by re-milking the cow after the ordinary daily 
supply has been drawn, and contains much cream and but 
little curd. Assimilable proportions of this are : — 

Strippings 2 tablespoonfuls. 

Water 4 tablespoonfuls. 

And if the small amount of caseine in such a mixture be 
still undigested : — 

Strippings 3 tablespoonfuls. 

Barley water 3 tablespoonfuls. 

Another good food is that recommended by Dr. A. V. 
Meigs. It consists of a combination of two parts of the 
cream, containing from fourteen to sixteen per cent, of fat ; 
one part average milk ; two parts lime water, and three parts 
sugar water, the latter consisting of seventeen and three- 
fourth drachms* of milk sugar to one pint of water. This 
makes an alkaline mixture with the percentage of its ingre- 
dients closely corresponding to human milk. 

When, in spite of careful preparation, all of these foods 
give rise to indigestion with fever, and the expulsion, by 
vomiting and diarrhoea, of hard curds from the stomach and 
intestines, the expedient of predigesting the milk must be 
resorted to. There are several ways of artificially digesting 
milk. 

One plan, recommended by Eustace Smith, is to add to 
each fluidounce of milk five grains of pure pepsin and four 
drops of dilute muriatic acid ; digest in a water-bath, at a 
temperature of ioo° F., until the mixture becomes clear, 

* About eighteen teaspoonfuls. 



144 HYGIENE OF THE NURSERY. 

then neutralize with bicarbonate of sodium, and the milk is 
ready for use. 

Another method is to peptonize the milk by pancreatine 
That manufactured under the name of extractum pancreatis, 
by Fairchild Brother & Foster, of New York, has proved 
most efficient in my hands. To accomplish this artificial 
digestion, put into a clean quart bottle five grains of ex- 
tractum pancreatis, fifteen grains of bicarbonate of sodium, 
and four fluidounces of cool, filtered water ; shake thoroughly 
together, and add a pint of fresh, cool milk. Place the bottle 
in water, not so hot but that the whole hand can be held in 
it for a minute without discomfort, and keep the bottle there 
for exactly thirty minutes. At the end of that time put the 
bottle on ice to check further digestion and keep the milk 
from spoiling. The fluid obtained, while somewhat less 
white in color than milk, does not differ from it in taste ; if, 
however, an acid be added, the caseine, instead of being 
coagulated into large, firm curds, takes the form of minute, 
soft flakes, or readily broken-down feathery masses of small 
size. When the process is carried just to the point 
described, the caseine is only partly converted into peptone ; 
but every succeeding moment of continued warmth lessens 
the amount of caseine until peptonization is complete. Then 
the liquid is grayish yellow in color, has a distinctly bitter 
taste, and shows no coagulation whatever on the addition 
of an acid. This artificial digestion, therefore, may be car- 
ried just as far as circumstances indicate, although it is 
ordinarily best to stop it short of complete conversion, as 
children object to the markedly bitter taste, and often, on 
account of it, absolutely refuse the food. Partial peptoniza- 
tion, too, is usually sufficient to adapt the milk to ready 

* The subject of peptonization is further considered in Chapter ix. 




FOOD. 145 

assimilation. To seize the proper moment for arresting the 
process, the person conducting it must be told to taste the 
milk from time to time, and as soon as the least bitterness 
is appreciable to remove the bottle from the hot water and 
place it upon ice for cooling and use. Such milk may be 
sweetened with sugar of milk, and given pure or diluted 
with water. For an infant of six weeks each meal may 
consist of: — 

Peptonized milk . . 6 tablespoonfuls. 

Milk sugar l / z teaspoonful. 

Water 2 tablespoonfuls. 

To this cream may be added when desirable, and by di- 
minishing the quantity of water and increasing that of milk 
the strength of the food may be made greater at any time. 

Although every precaution be taken, the last of a quan- 
tity of predigested food is very apt to grow bitter ; and if 
the attendants will take the trouble, it is much better to pep- 
tonize every meal separately. This is readily done by 
obtaining a number of powders of pancreatin and bicarbonate 
of sodium, so proportioned that each packet shall contain 
the proper amount for one bottle of food. 

For example : — 

R . Ext. pancreatis gr. ix. 

Sodii bicarb gr. xxiv. 

M. et ft. chart, (waxed papers) No. xij. 
S. — rut one powder into a nursing bottle with two fluidounces of filtered 
water and two fluidounces of fresh sweet milk ; shake together and keep 
warm in a water-bath for about half an hour before feeding; sweeten 
with half a teaspoonful of milk sugar. 

The great advantages of partial peptonization are that 
the necessity for lime water, barley water and thickening 
substances to keep apart the curd is done away with, and 
10 



I46 HYGIENE OF THE NURSERY. 

that, when the digestive disturbance requiring a careful pre- 
paration of food is removed, an ordinary milk diet can be 
gradually resumed by regularly diminishing the time arti- 
ficial digestion is allowed to progress. This changes the 
caseine in a less and less degree, until, finally, it is taken in 
its natural form. 

Instead of this ordinary peptonizing process, I have for 
the past year or more employed the " Peptogenic milk pow- 
der," prepared by the chemists already referred to. This 
powder contains a digestive ferment, pancreatin ; an alkali, 
bicarbonate of sodium ; and a due proportion of mil]<: sugar. 

The mode of employment is as follows : — 

Take of — 

Milk 4 tablespoonfuls. 

"Water 4 tablespoonfuls. 

Cream I table spoonful. 

Peptogenic milk powder ...... I measure.* 

This mixture is to be heated over a brisk flame to a point 
that can be comfortably sipped by the preparer (about 
1 1 5° F.) and kept at this heat for six minutes. When 
properly prepared, the resultant, so-called " humanized 
milk," presents the albuminoids in a minutely coagulable 
and digestible form, has an alkaline reaction, contains the 
proper proportion of salts, milk sugar and fat, and has the 
appearance of human milk. 

Leeds gives the following analysis of this prepared milk : — 

Water . 86.2 per cent. 

Fat '4.5 

Milk sugar 7. " 

Albuminoids 2. " 

Ash (salts) 0.3 " 

* Measure provided with each can of powder. 



FOOD. 147 

This corresponds very closely with his average analysis 
of human milk. 

In using this powder, too, one can readily return to a 
plain milk diet by gradually shortening the time of heating ; 
in other words, by slowly diminishing predigestion. 

Sometimes milk, in every form and however carefully pre- 
pared, ferments soon after being swallowed and excites 
vomiting, or causes great flatulence and discomfort, while it 
affords little nourishment. With these cases the best plan 
is to withhold milk entirely for a time and try some other 
form of food. The following are good substitutes : — 

Mellin's Food I teaspoonful. 

Hot water 6 tablespoonfuls. 

For each portion ; to be given every two hours at the age of six weeks. 

Veal broth {y z It), of meat to the pint) . 3 tablespoonfuls. 
Barley water 3 tablespoonfuls. 

For one portion. 

Whey 3 tablespoonfuls. 

Barley water 3 tablespoonfuls. 

Milk sugar y z teaspoonful. 

A teaspoonful of the juice of raw beef* every two hours 
will usually be retained when everything else is rejected. 

Such foods are only to be used temporarily until the 
tendency to fermentation within the alimentary canal 
ceases ; then milk may be gradually and cautiously 
resumed. 

When infants who are approaching the end of the first 
year become affected with indigestion, it is often sufficient 
to reduce the strength and quantity of the food to a point 
compatible with digestive powers. For instance, at eight 

* See Chapter ix. 



I48 HYGIENE OF THE NURSERY. 

months the food may be reduced to that proper for a healthy 
child of six months, or even less. Here, too, predigestion 
of the food is very serviceable. If a few grains of extractum 
pancreatis be added to a gobletful of thick, well-boiled starch 
gruel, at a temperature of ioo° F., the gelatinous mucilage 
quickly grows thinner and soon is transformed into a fluid, 
the starch having been rendered soluble by the action of 
the pancreatin; by still longer contact, the hydrated starch 
is converted into dextrine and sugar. Advantage may be 
taken of this property to render the foods containing 
starch assimilable. Thus, to a mixture of barley jelly 
and milk, e. g.\ — 

Barley jelly 2 teaspoonfuls. 

Milk sugar 1 teaspoonful. 

Warm milk 16 tablespoonfuls. 

add three grains of extractum pancreatis, and five grains of 
bicarbonate of sodium, and keep warm for half an hour before 
administering. 

The same process may be employed with food containing 
oatmeal, arrowroot or wheaten flour, with the effect of con- 
verting the starchy ingredients into digestible elements 
without materially altering the taste. 

When the infant has arrived at an age to take meat 
broths, these too may be readily peptonized when digestion 
is enfeebled.* 

Returning to the regimen of the healthy infant, it will be 
found that after the first year far less change is required in 
the food from month to month. 

Diet from the twelfth to the eighteenth month, five meals 
per day: — 

* See Chap. ix. 



FOOD. I49 

First meal, 7 a. m. — A slice of stale bread, broken and 
soaked in a breakfast-cup (eight fluidounces) of new milk. 

Second meal, 10 a.m. — A teacup of milk (six fluidounces) 
with a soda biscuit or thin slice of buttered bread. 

Third meal, 2 p.m. — A teacup of beef tea (six fluidounces) 
with a slice of bread. One good tablespoonful of rice-and- 
milk pudding. 

Fourth meal, 6 p. m. — Same as first. 

Fifth meal, 10 p.m. — One tablespoonful of Mellin's Food 
with a breakfast-cupful of milk. 

To alternate with this : — 

First meal, 7 a. m. — The yelk of an egg lightly boiled, 
with bread crumbs ; a teacupful of new milk. 

Second meal, 10 a.m. — A teacupful of milk with a thin 
slice of buttered bread. 

Third meal, 2 p. m. — A mashed, boiled potato, moistened 
with four tablespoonfuls of beef tea ; two good tablespoon- 
fuls of junket. 

Fourth meal, 6 p.m. — A breakfast-cupful of new milk with 
a slice of bread broken up and soaked in it. 

Fifth meal, 10 p.m. — Same as second. 

The fifth meal is often unnecessary, and sleep should 
never be disturbed for it; at the same time, should the child 
awake an hour or more before the first meal, he must break 
his fast upon a cup of warm milk, and not be allowed to go 
hungry until the set breakfast hour. 

Diet from eighteen months to the end of two and one- 
half years, four meals a day: — 

First meal, 7 a. m. — A breakfast-cupful of new milk ; the 
yelk of an egg lightly boiled ; two thin slices of bread and 
butter. 

Second meal, 1 1 a. m. — A teacupful of milk with a soda 
biscuit. 



150 HYGIENE OF THE NURSERY. 

Third meal, 2 p.m. — A breakfast-cupful of beef tea, mutton 
or chicken broth ; a thin slice of stale bread ; a saucer of 
rice-and-milk pudding. 

Fourth meal, 6.30 p. m. — A breakfast-cupful of milk with 
bread and butter. 

On alternate days : — 

First meal, 7 a. m. — Two tablespoonfuls of thoroughly 
cooked oatmeal or wheaten grits with sugar and cream ; a 
teacupful of new milk. 

Second meal, 1 1 a. m.— A teacupful of milk with a slice 
of bread and butter. 

Third meal, 2 p. m. — One tablespoonful of underdone 
mutton pounded to a paste ; bread and butter, or mashed 
baked potato, moistened with good plain dish gravy ; a sau- 
cer of junket. 

Fourth meal, 6.30 P. m. — A breakfast-cupful of milk, a slice 
of soft milk toast, or a slice or two of bread and butter. 

When sickness supervenes, all that is ordinarily necessary 
is a reduction of the diet to plain milk, or milk with Mel- 
lin's Food. 

An important point often neglected is the matter of drink. 
Even the youngest infant requires water several times daily, 
and the demand increases with age. The water must be as 
pure as possible and should not be too cold, although in the 
.heat of summer bits of ice and water moderately cooled 
by ice can be allowed without harm. 

The foregoing schedule must, of course, be regarded only 
as an average. Many children can bear nothing but milk 
food up to the age of two or even three years, and, provided 
enough be taken, no fear for their nutrition need be enter- 
tained. If a child be thriving on milk, he is never to be 
forced to take additional food merely because a certain age 
has been reached ; let the healthy appetite be the guide. 



FOOD. 



15 



d. Success in hand-feeding depends quite as much on the 
administration as upon the preparation of the food. 

From birth up to such time as broth, bread, and eggs are 
added to the diet, all the food should be taken from a bottle, 
and even after this ; as the bottle is a comfort and insures 
slow feeding, it may be allowed for milk preparations, until 

Fig. 16. 




GRADUATED NURSING BOTTLE. 



the child of his own accord tires of it. The only feeding 
apparatus to be admitted to the nursery is the simple bottle 
and tip. The bottle represented in the accompanying figure 
was prepared at my suggestion by Mr. J. J. Ottenger, of 
Philadelphia. Its interior surface presents no angles for the 



152 HYGIENE OF THE NURSERY. 

collection of milk; it is easily cleaned, and the graduated 
scale is convenient for nursery use. 

All complicated arrangements of rubber and glass tubing 
are not only an abomination, but a fruitful source of sick- 
ness and death. Rather than use them, it is far better to 
feed the infant with a spoon. In England, a bottle with a 
long rubber tube is almost universally employed. Should 
this be abandoned and a simple bottle and a rubber tip used, 
the objections of some authors to bottle-feeding would 
vanish. 

The bottle shaped as above must be of transparent flint 
glass, so that the slightest foulness can be detected at a 
glance, and may vary in capacity from six to twelve fluid- 
ounces, according to the age of the child. Two should be 
on hand at a time, to be used alternately. Immediately after 
a meal the^bottle must be thoroughly washed out with scald- 
ing water, filled with a solution of bicarbonate or salicylate 
of sodium — one teaspoonful of either to a pint of water — 
and thus allowed to stand until next required; then the soda 
solution being emptied, it must be thoroughly rinsed with 
cold water before receiving the food. The tips or nipples, of 
which there should also be two, must be composed of soft, 
flexible India-rubber, and a conical shape is to be 
preferred, as being more readily everted and 
cleaned ; the opening at the point must be free, but 
not large enough to permit the milk to flow in 
a stream without suction. At the end of each 
feeding the nipple must be removed at once from 
the bottle, cleansed externally by rubbing with a 
stiff brush wet with cold water, everted and 
treated in the same way, and then placed in cold water and 
allowed to stand in a cool place until again wanted. 

While taking these precautions for perfect cleanliness, the 




BOTTLE TIP. 



FOOD. 153 

nurse must satisfy herself of their efficacy by smelling both 
the bottle and the tip just before they are used, to be sure 
of the absence of any sour odor. 

Next to cleanliness of the feeding apparatus, it is import- 
ant to insist upon the separate preparation of each meal 
immediately before it is to be given. The practice of making 
in the morning the whole day's supply of food, though it 
save trouble, is a most dangerous one. Changes almost in- 
variably take place in the mixture, and by the close of the 
day it becomes unfit for consumption. 

When the graduated bottle is not at hand, a common 
glass graduate, marked for fluidrachms and ounces and 
holding a pint, should be provided for the nursery. Some 
moments before meal-time, so as to avoid hurry, the differ- 
ent fluid ingredients of the food are to be measured in this, 
one after the other ; the requisite quantity of milk sugar is 
then added, and the whole mixed thoroughly, by stirring 
with a spoon, and poured into the feeding bottle. When 
the graduated bottle is employed, thorough shaking is suffi- 
cient. The food must now be heated to a temperature of 
about 95 F. This can be done by steeping the bottle in hot 
water, or by placing it in a water-bath over an alcohol lamp 
or gas jet. Finally, the tip is applied and the meal is ready. 

When feeding, the child must occupy a half-reclining 
position in the nurse's lap. The bottle should be held by 
the nurse, at first horizontally, but gradually more and more 
tilted up as it is emptied, the object being to keep the neck 
always full and prevent the drawing in and swallowing of 
air. Ample time, say five, ten or fifteen minutes, according 
to the quantity of food, should be allowed for the meal. It 
is best to withdraw the bottle occasionally for a brief rest, 
and after the meal is over, sucking upon the empty bottle 
must not be allowed, even for a moment. 



154 HYGIENE OF THE NURSERY. 

e. For children residing in cities, an honest dairyman 
must be found, who will serve sound milk and cream from 
country cows once every day in winter and twice during 
the day in the heat of summer. The milk of ordinary stock 
cows is more suitable than that from Alderney or Durham 
breed, as the latter is too rich and, therefore, more difficult 
to digest. The mixed milk of a good herd is to be preferred 
to that from a single animal. It is less likely to be affected 
by peculiarities of feeding, and less liable to variation from 
alterations in health or different stages of lactation. 

The care of the herd and of the milk is of great conse- 
quence. The cows should be healthy, and the milk of any 
animal that seems indisposed should not be mixed with that 
from perfectly healthy animals. The cows must not be fed 
upon swill or the refuse of breweries, glucose factories, or 
any other fermented food. They must not be allowed to 
drink stagnant water, and must not be heated or worried 
before being milked. The pasture must be free from noxious 
weeds, and the barn and yard must be kept clean. The 
udders should be washed, if dirty, before the milking. The 
milk must be at once thoroughly cooled. This is best 
accomplished by placing the can in a tank of cold spring 
water, or in ice water, the water being of the same depth as 
the milk in the can. It is well to keep the water in the 
tank flowing; indeed, this is necessary unless ice water 
be used. The can should remain uncovered during the 
cooling and the milk should be gently stirred. The 
temperature should be reduced to 6o° F. within an hour, 
and the can must remain in the cold water until the time 
for delivering. 

In summer, when ready for delivery, the top should be 
placed in position and a cloth wet in cold water spread over 
the can, or refrigerator cans may be used. At no season 



FOOD. 155 

should the milk be frozen, but at the same time no buyer 
should receive milk having a temperature over 65 ° F. 

The milk and cream must be transported from the dairy 
in perfectly clean vessels. To insure this it is best to pro- 
vide two sets of small cans, one set to be thoroughly 
cleansed and aired while the other is taken away by the 
milkman to carry back the next supply. So soon as this 
arrives in the morning, or in the morning and evening in 
hot weather, the cans should be emptied into separate and 
absolutely clean earthenware or glass pitchers, and these 
put at once into a refrigerator reserved exclusively for them. 
This may stand in some convenient spot near the nursery, 
but not in it, and especially not in an adjoining bath room. 
With a good refrigerator there is no difficulty in keeping 
milk perfectly sweet for twenty-four hours in winter and for 
twelve hours in summer, except on intensely hot days ; then 
it may be necessary to scald or lightly boil the whole of 
the supply when received, in order to prevent change. 

It is a well-known fact that milk is a fluid having active 
powers of absorption, and that it frequently acts as the 
medium of transmission of the contagion of such diseases 
as scarlatina, diphtheria and typhoid fever. Doctor V. C. 
Vaughan has also lately discovered in milk a special poison 
which he terms tyrotoxicon (cheese poison). 

The clinical element of interest in these discoveries is 
the close analogy between the symptoms produced by the 
experimental use of tyrotoxicon and those observed in cholera 
infantum — an analogy suggestive of the possibility of the 
latter disease being chiefly due to poisoned milk. This 
causal relation is scarcely more than a theory, though cer- 
tain well-known features of the disease seem to bear it out. 
Thus, the affection occurs at a season when decomposition 
of milk takes place most rapidly ; it occurs at places where 



I56 HYGIENE OF THE NURSERY. 

absolutely fresh milk cannot be obtained ; it prevails among 
classes of people whose surroundings are most favorable to 
fermentative changes ; it is most fatal at an age when there 
is the greatest dependence upon milk as a food, when the 
gastro-intestinal mucous membrane is most susceptible to 
irritants, and when irritation and nervous fevers are most 
easily produced. 

Drs. Newton and Wallace, of the New Jersey State Board 
of Health, have reported a number of cases of poisoning by 
milk that occurred in different hotels at Long Branch. These 
observers found that the affected milk was all obtained from 
one milkman, and that the cows furnishing it were milked 
at the unusual hours of midnight and noon. The noon 
milking was immediately placed in cans without being 
cooled, and " carted eight miles during the warmest part of 
the day in a very hot month." It was this milk that pro- 
duced the poisonous effects, the morning's milk being always 
good. No statement is made as to the health of the cows 
or the nature of the poison, but there is a probability of its 
having been tyrotoxicon, and of this material or its ferment 
having been generated by the careless collection and trans- 
portation of the milk, combined with the high atmospheric 
temperature. 

Childhood. — Children who have cut their milk teeth 
may be fed for a twelvemonth — namely, up to the age of 
three and a half years — in the following way: — 

First meal, 7 a. m. — One or two tumblerfuls of milk, a 
saucer of thoroughly cooked oatmeal or wheaten grits, and 
a slice of bread and butter. 

Second meal, 11 a. m. (if hungry). — A tumblerful of milk 
or a teacupful of beef tea with a biscuit. 

Third meal, 2 p. m. — A slice of underdone roast beef or 
mutton or a bit of roast chicken or turkey, minced as fine 



FOOD. 157 

as possible ; a baked potato thoroughly mashed with a fork 
and moistened with graVy; a slice of bread and butter; a 
saucer of junket or rice-and-milk pudding. 

Fourth meal, 7 p. m. — A tumblerful of milk and one or 
two slices of well-moistened milk toast. 

From three and a half years up the child must take his 
meals at the table with his parents, or with some reliable 
attendant who will see that he eats leisurely. The diet, 
while plain, must be varied. The following list will give an 
idea of the food to be selected : — 



BREAKFAST. 

EVERY DAY. ONE DISH ONLY EACH DAY. 

Milk. Fresh fish. Eggs, plain omelette. 

Porridge and cream. Eggs, lightly boiled. Chicken hash. 

Bread and butter. " poached. Stewed kidney. 

" scrambled. " liver. 

Sound fruits may be allowed before or after the meal, 
according to taste, as oranges, grapes without pulp (seeds 
not to be swallowed), peaches, thoroughly ripe pears, canta- 
loupes and strawberries. 

DINNER. 

EVERY DAY. TWO DISHES EACH DAY. 

Clear soup. Potatoes, baked. Hominy. 

Meat, roasted or " mashed. Macaroni, plain. 

broiled, and cut into Spinach. Peas. 

small pieces. Stewed celery. String-beans, young. 

Bread and butter. Cauliflower. Green corn, grated. 

Junket, rice-and-milk or other light pudding, and occasionally ice cream, 
may be allowed for dessert. 

SUPPER. 

EVERY DAY. 
Milk. 

Milk toast or bread and butter. 
Stewed fruit. 



I58 HYGIENE OF THE NURSERY. 

Fried food, highly-seasoned or made-up dishes are to be 
excluded; no condiment but salt is to be used, and the 
formation of a habit of eating between meals must be 
avoided. 

Filtered or spring water should be the only drink; tea, 
coffee, wine or beer being entirely forbidden. 

As to the quantity, a healthy child may be permitted to 
satisfy his appetite at each meal, under the one condition 
that he eats slowly and masticates thoroughly. 

In case of illness, the diet must be reduced in quantity 
'and quality, according to the rules that are applicable to 
adults. 



DIETARY. I59 



CHAPTER IX. 

DIETARY. 

In the preceding chapter so much attention has been 
devoted to the subject of the artificial feeding of infants, 
and so many formulas have been givew for the preparation 
of cows' milk as a substitute for the natural food, or human 
milk, that it will only be necessary here to refer briefly to a 
few milk mixtures, some of which have been recommended 
by other writers. After describing these, the methods of 
peptonization will be discussed, and finally the mode of 
preparing a number of dishes adapted to the nursery 
whether occupied by well or ill children. In regard to the 
latter, however, the dishes that ordinarily come upon the 
table will not be referred to, as any good cook ought to 
know how to make them. 

MILK FOODS. 

ARROWROOT FOOD. 

Milk, 
Cream, 
Lime water, 

Arrowroot water Of each 2 tablespoonfuls. 

Sugar 1 teaspoonful. 

This is the late Dr. J. F. Meigs' formula for a child of 
about nine months of age. The arrowroot water is made 
in the proportion of one teaspoonful of arrowroot to a pint 
of boiling water. 



l6o HYGIENE OF THE NURSERY. 

CHAVASSE'S MILK FOOD. 
New milk, 

Water, warm Of each equal parts. 

Table salt A small pinch. 

Lump sugar . . A sufficient quantity to slightly sweeten the mixture. 

Let the milk and the water be of the same temperature — 
90 F. — before mixing. This preparation does well for a 
child of three or four months ; the total quantity for each 
meal being from eight to twelve tablespoonfuls. 

CONDENSED MILK. 

Condensed milk I teaspoonful. 

Water 6 tablespoonfuls. 

Use hot water ; mix by stirring and let the temperature 
fall to ordinary heat before administration. 

MILK AND CINNAMON. 

Milk sugar _ . . . 1 teaspoonful. 

Brandy 1 teaspoonful. 

Milk y z pint. 

Powdered cinnamon A sufficiency to flavor. 

Mix thoroughly. 

Useful in diarrhcea ; may be administered warm or cold. 

MILK AND OATMEAL. 

Bethlehem oatmeal (fine powder) . . . . 1 teaspoonful. 

Water 2 tablespoonfuls. 

Milk 5 tablespoonfuls. 

Cream 1 tablespoonful. 

Sugar of milk I teaspoonful. 

Heat the water just short of boiling; stir in the oatmeal 



DIETARY. l6l 

slowly until a smooth white mixture is obtained ; then add 
the other ingredients. 

This is adapted for an infant of three months, and forms 
a useful mixture in cases of constipation. 

MILK-SUGAR FOOD. 

Milk I tablespoonful. 

Cream 2 tablespoonfuls. 

Lime water 2 tablespoonfuls. 

Milk-sugar solution 3 tablespoonfuls. 

For a child under a month, quantity to be increased as 
age advances, but no change to be made in quality until 
after the eighth or ninth month. 

The milk-sugar solution consists of 17J4 drachms — a little 
over 17 teaspoonfuls of milk sugar to a pint of pure water. 

This is the food recommended by Dr. A. V. Meigs. 

MILK AND WHITE-OF-EGG FOOD. 

The whites of three eggs. 

Lime water 3 tablespoonfuls. 

Milk 1 pint. 

Shake the egg and lime water forcibly together for five 
minutes ; then add the milk slowly with constant stirring, 
occupying ten minutes in the process ; keep in a cool place. 



PEPTONIZED FOODS. 

For the process of peptonization, or predigestion, the Ex- 
tractum Pancreatis, prepared by Fairchild Bros, and Foster, 
of New York, gives, in my experience, the most satisfactory 
results, and in all the receipts given below, this preparation 
is to be used. 
11 



1 62 HYGIENE OF THE NURSERY. 

PEPTONIZED MILK, No. i. 

One peptonizing tube. 

Water I teacupful. 

Milk, fresh and cold ... I pint. 

Put the powder contained in the tube into a clean quart 
bottle; add the cold water and shake well; then pour in the 
milk and shake the mixture thoroughly again. Place the 
bottle in water of about 1 1 5 ° F., or so hot that the whole 
hand can be held in it without discomfort for a minute, and 
keep the bottle there for twenty minutes. Then put the 
bottle in contact with ice to check further digestion and keep 
the milk from spoiling. 

Peptonized milk should have a slightly but not decidedly 
bitter taste. It may be made palatable by serving with 
grated nutmeg, sugar, or a little brandy, or it may be taken 
with Apollinaris or Vichy water. In the latter case put 
the water first into the glass, then quickly pour in the pep- 
tonized milk and drink while effervescing. 

PEPTONIZED MILK, No. 2. 

Mix the peptonizing powder, water and milk, in a bottle, 
and place in a hot-water bath exactly as directed in the 
above. Let the bottle remain in the hot water for two hours, 
then pour into a saucepan and heat to boiling. This spe- 
cially peptonized milk is used in making jellies, etc. It may 
be immediately used if required hot, or set aside on ice for 
punches, etc. 

The object of raising the liquid to the boiling point is 
to abolish the activity of the pancreatin, so that it may 
not act secondarily upon other substances prepared with 
the milk. 



DIETARY. 163 

SLIGHT PEPTONIZATION. 

Take the same ingredients and mix them as before, but 
immediately place the bottle on ice without subjecting it to 
any heat. 

This preparation is useful in cases of enfeebled digestive 
power, or as a means of returning from predigested to ordi- 
nary milk. It has no especial taste. 

PEPTONIZED MILK GRUEL. 

One peptonizing tube. 

Wheat flour or arrowroot I heaping teaspoonful. 

Water, cold l / z pint. 

Milk, cold 1 pint. 

Make a smooth mixture of the arrowroot and water; heat 
this with constant stirring until it has boiled briskly for 
three minutes ; next add the milk ; strain into a pitcher and 
stir in the peptonizing powder ; let the mixture stand in the 
hot-water bath, 1 1 5 ° F., for thirty minutes; then pour into 
a clean bottle and place on ice. 

PEPTONIZED MILK PUNCH. 

Fill an ordinary thin glass tumbler one-third full of 
cracked ice ; pour on it from one to four teaspoonfuls, ac- 
cording to the child's age, of St. Croix rum, and a dash of 
Curacoa ; add sugar to taste, and then fill the glass with 
peptonized milk ; shake well and grate a little nutmeg on 
top ; strain. 

EFFERVESCING MILK PUNCH. 

Prepare the tumbler and ice as in the above, squeeze in the 
juice of half a lemon, add sugar to sweeten, and fill the glass 
with half Apollinaris and half peptonized milk. The milk 
used in this punch must be prepared by the second process. 



164 HYGIENE OF THE NURSERY. 

PEPTONIZED BEEF TEA. 

To one-quarter of a pound of minced raw beef, entirely 
free from fat, add one-half pint of cold water ; cook over a 
slow fire, with constant stirring, until it has boiled a few 
minutes, then pour off the liquor and beat or rub the meat 
to a paste ; put the latter into a jar with one-half pint of 
cold water, and pour in the liquor previously obtained. Add 
to this mixture thirty grains of Extract of Pancreas and 
twenty grains of bicarbonate of sodium ; shake all well to- 
gether, and keep at a temperature of about no° F., stirring 
occasionally, for three hours. Next boil quickly, strain, 
and serve as required. 

PEPTONIZED OYSTERS. 
(Originally suggested by the late Dr. N. A. Randolph.) 

Take half a dozen large oysters with their juice and half 
a pint of water. Heat in a saucepan until they have boiled 
briskly for a few minutes. Pour off the broth and set aside. 
Mince the oysters fine, and reduce them to a paste with a 
potato masher in a wooden bowl. Next put the oysters in 
a glass jar with the broth which has been set aside and add 
the contents of a peptonizing tube. Let the jar stand in hot 
water or in a warm place, where the temperature is not above 
1 1 5° F., for one and a half hours. Next pour into a sauce- 
pan and add half a pint of milk ; heat over the fire slowly 
to boiling point, and flavor with salt to taste, and serve hot. 

"HUMANIZED MILK." 

Peptogenic milk powder .' . I measure.* 

Milk, fresh and cold 4 tablespoonfuls. 

Water 4 tablespoonfuls. 

Cream I tablespoonful. 

* The proper measure is furnished with each box of powder. 



DIETARY. 165 

Heat cautiously over a flame for six minutes, stirring 
constantly with a spoon and tasting often, so that it shall 
not get too hot to be sipped — 1 1 5 ° F. Now put into a nurs- 
ing bottle, and it is ready for feeding. The cup should be 
held by the hand, over the flame, thus making it easy to 
regulate the heat to which the milk is exposed. 

It is important to follow out these directions absolutely, 
for should the temperature of the mixture not be maintained 
at a sufficiently high point, the Pancreatin contained in the 
peptogenic powder will perform its work imperfectly ; on 
the other hand, should the heat be too great all digestive 
activity will be suspended. 

Humanized milk so prepared is adapted to the average 
infant's digestion. As age advances, the proportion of milk 
must be increased and the total quantity of the mixture 
augmented. As an increase in quantity is made, it is neces- 
sary to preserve the relations of the peptogenic powder to 
the liquid, namely, one measure to each four ounces and a 
half. 

Sometimes it will be found necessary to carry the pro- 
cess of predigestion further than can be accomplished by 
following the directions already given. This may be 
readily done by increasing the length of the time of heat- 
ing, thus, one can easily produce in the milk any degree of 
change up to complete peptonization, when the liquid 
becomes clear and very bitter. Conversely, when it is 
desirable, in case of returning health, for instance, to 
resume a plain milk diet, the time of heating is gradually 
shortened until the powder is added to the milk mixture 
just at the time of feeding. When the time comes to 
abandon the digesting powder entirely, it is most important 
to supply its place in the food by an equal bulk of milk 
sugar. 



1 66 HYGIENE OF THE NURSERY. 

The milk and cream referred to are of such quality as 
can be obtained from a reliable city server ; extra rich milk 
or cream may, under some circumstances, require to be 
more diluted. 

MEAT BROTHS, ETC. 
BEEF TEA, No. i. 

Take one pound of lean beef and mince it ; put it, with 
its juice, into an earthen vessel containing a pint of clear 
water at a temperature of 85 ° F., and let the whole stand 
for one hour. Strain well through stout muslin, squeezing 
all juice from the meat ; place on the fire, and, while stir- 
ring briskly, slowly heat the liquid just to the boiling point. 
Then remove at once and season with salt. 

When administering this be careful to stir up whatever 
sediment may be present. 

BEEF TEA, No. 2. 

Take half a pound or a pound — according to strength 
required — of rump steak ; cut it into small pieces ; free it 
completely from fat and tendon, and put it with one pint of 
clear, cold water into a covered saucepan. Place by the 
side of the fire for five hours ; then let it simmer gently 
for two hours, and finally skim thoroughly. The meat 
used should be as fresh as possible, and the saucepan 
should be of copper or tin, or be enameled on the inner 
surface. 

Beef tea must never be allowed to boil, and in reheating 
be careful to raise it only to the proper point for drinking. 

BEEF TEA IN FIFTEEN MINUTES. 

Scrape one pound of lean beef into fibres, and, after 
placing it in a clean saucepan, pour on half a pint of boil- 
ing water ; then cover the saucepan closely, and place it by 



DIETARY. 167 

the side of the fire for ten minutes ; next strain into a tea- 
cup ; place this in a basin of ice-cold water and remove all 
fat from the surface of the liquid, first with a spoon and 
finally with a piece of stale bread or blotting paper ; then 
pour into a warm cup and heat gently to the temperature 
for drinking. 

BEEF ESSENCE, No. 1. 

Thoroughly mince one pound of rump steak ; place it 
with three tablespoonfuls of water in a mortar ; pound it 
well and put it aside to soak for two hours. Then put it, 
with a pinch of salt, in a covered earthen jar; cement the 
edges of the cover with dough and tie a piece of cloth over 
the top. Place the jar in a pot half full of boiling water, 
and keep the whole on the fire, simmering, for four hours. 
Then, through a coarse sieve, strain off the liquid essence, 
which will amount to about six ounces. 

One teaspoonful will be sufficient for a young child. 

BEEF ESSENCE, No. 2. 

Half a pound of fresh beef must be minced as finely as 
possible ; add to this half a pint of pure cold water, an egg- 
spoonful of salt and five drops of pure muriatic acid. Mix 
well, and after standing an hour pass through a conical sieve 
without pressure, refiltering until the liquid runs clear. 
Next a second half pint of water is poured on the residue 
upon the sieve and allowed to filter through without pressure. 

The dose of this is two tablespoonfuls for a child of twelve 
years, a teaspoonful for one under one year. 

RAW-BEEF JUICE. 

Take one pound of sirloin of beef; warm it in a broiler 
before a quick fire ; cut into pieces half an inch square, and 
after placing in a lemon squeezer or meat press, forcibly ex- 



1 68 HYGIENE OF THE NURSERY. 

press the juice ; remove the fat that rises to the surface after 
cooling. 

This may be given warm or cold, and seasoned with a 
little salt, in doses of one teaspoonful every two hours to a 
child of six months or a year old. 

The meat must never be actually cooked. 

RAW BEEF. 

Cut a tenderloin beefsteak into the finest possible pieces 
and free it as nearly as may be from particles of fat ; then 
place in a mortar and pound until the meat becomes pulpy; 
next rub through a fine sieve and season with salt and a 
little black pepper. 

A teaspoonful of this pulp three or four times daily will 
be sufficient for a child of one year old. 

CLEAR BROWN SOUP. 

Cut a shin of beef into pieces; put it into a saucepan with 
just enough water to cover it; when it boils, skim it, and 
add a bundle of sweet herbs, a little turnip, carrot, onion 
and celery, also a little pepper and salt. Let the whole boil 
until the meat is quite tender ; then strain, and let it stand 
till the next day. After clearing it thoroughly from fat, 
heat it again, adding as much browning as will make the 
soup the color you like. Beat up two eggs, with their shells 
crushed, till they are quite a froth. Put them into the soup 
with a whisk ; let it boil gently for ten minutes; then strain 
it through a cloth, and it will be perfectly bright. (Dr. 
Ellis.) 

CONSOMME. 

Make a beef broth by taking one or two pounds of beef, 
according to the strength required, from the leg, round or 
chuck; wash well; cut in pieces and put on to boil in three 



DIETARY. 169 

quarts of cold water. While boiling, skim frequently, and 
when reduced to one quart, take from the saucepan and 
strain ; after which return to the saucepan with a few thin 
slices of onion, and half a pound of lean beef, chopped fine, 
and well mixed with three raw eggs ; beat all thoroughly 
with the broth, which is to be returned to the fire and boiled 
for about half an hour, or until perfectly clear. 

CHICKEN BROTH. 

A small chicken, or half of a large fowl, thoroughly 
cleaned, and with all the skin and fat removed, is to be 
chopped, bones and all, into small pieces ; put these, with a 
proper quantity of salt, into a saucepan and add a quart of 
boiling water ; cover closely and simmer over a slow fire for 
two hours ; after removing, allow to stand, still covered, for 
an hour, and strain through a sieve. 

MUTTON BROTH. 

Lean loin of mutton . . . I pound (exclusive of bone). 
Water 3 pints. 

Boil gently until very tender, adding a little salt or onion, 
according to taste ; strain into a basin, and, when cold, skim 
off all the fat. Warm when served. 

Should barley or rice be added, they must be first sepa- 
rately and thoroughly boiled, and added when the broth is 
heated for use. 

VEAL BROTH. 

Lean veal ^ to I pound, according to 

strength required. 
Cold water 1 pint. 

Mince the meat ; pour upon it a pint of cold water ; let 
it stand for three hours ; then slowly heat to boiling point, 



170 HYGIENE OF THE NURSERY. 

and after boiling briskly for two minutes, strain through a 
fine sieve and season with salt. 



OYSTER SOUP. 

Drain one pint of oysters through a colander for five 
minutes, to remove the liquor, and then pour over them one 
pint of boiling water, which must be thrown aside ; add to 
the liquor already drained a pint of boiling water and put 
over the fire in a porcelain-lined saucepan. Boil until all 
the scum has risen and been skimmed off; then add half a 
pint of fresh milk, one water cracker rolled to a powder, a 
piece of butter, and a little salt and pepper ; boil ten min- 
utes, and just before the soup is to be served turn in the 
oysters from the colander and let them scald for three 
minutes. 

ARROWROOT PUDDING. 

Mix a tablespoonful of arrowroot with cold water; put it 
over the fire in a porcelain-lined saucepan ; add a pint of 
boiling milk — stirring constantly — and one egg well beaten 
with a tablespoonful of white sugar ; let it boil five or ten 
minutes. 

If baked pudding is preferred, it may be mixed in the 
same way and baked, in a moderately quick oven, for 
twenty or thirty minutes. 

BLANC MANGE. 

Gelatine j4 ounce. 

Water }4 pint. 

Cream I pint. 

White sugar 3 ounces. 

Extract of lemon Sufficient to flavor. 

Dissolve the gelatine in the water by means of heat, 
meanwhile whipping the cream and sugar together and 



DIETARY. 171 

adding the lemon. Next, while the gelatine solution is 
still warm, pour in the cream slowly, and beat until stiff 
enough to drop from the' spoon ; finally pour in moulds. 
Milk may be used instead of water in this preparation. 

HOMINY GRITS. 

Two tablespoonfuls of hominy, having been boiled soft, 
are rubbed up with butter until quite light ; then, half a 
pint of boiled milk is added slowly, with constant stirring ; 
next strain through a sieve and boil again; flavor with 
sugar or salt, and serve hot. Rice may be prepared in the 
same way. 

JUNKET. 

Milk 1 pint. 

Essence of pepsin, (Fairchild's) .... 2 teaspoonfuls. 
(Wine of pepsin or liquid rennet may also be used.) 

Heat the milk just to a temperature that can be readily 
borne in the mouth, and add, with gentle stirring, the curd- 
ling agent ; allow to stand until firmly curded, and serve 
with sugar, nutmeg or cream as desired. 

MILK AND GELATINE. 

Gelatine I tablespoonful. 

Barley water, hot . % pint. 

Powdered sugar 2 tablespoonfuls. 

Milk I pint. 

Dissolve the gelatine in the hot barley water ; add the 
sugar, and then the milk ; stirring all together. 

RICE-MILK. 

Rice 2 tablespoonfuls. 

Corn-starch I teaspoonful. 

Milk 2 pints. 



172 HYGIENE OF THE NURSERY. 

Boil in a farina boiler until each grain of the rice becomes 
saturated, and the whole creamy in color. 

RICE PUDDING. 

Take three ounces of rice, and swell it very gently in one 
pint of new milk. Let it cool ; then stir into it one ounce 
of fresh butter, two ounces of pounded sugar, the yelks of 
three eggs, and some grated lemon rind. Pour this into a 
well-buttered dish, but do not quite fill it, and then lay 
lightly over the top the whites of three eggs which have 
been well beaten up with three tablespoonfuls of sifted 
sugar. Put the pudding directly into the oven, the heat of 
which must be moderate, and bake it for about twenty min- 
utes, or till the egg crust has become lightly browned. 

OATMEAL GRUEL. 

Mix a large tablespoonful of oatmeal with two tablespoon- 
fuls of cold water, stirring to bring to a state of uniformity ; 
then pour into a pint of boiling water in a saucepan, and 
boil and stir well for ten minutes. Flavor with salt or 
sugar. 

If the boiling be continued for half an hour, the mixture 
thickens into a porridge. 

SAGO JELLY. 

Take two tablespoonfuls of sago ; wash carefully ; soak 
for four hours in a half pint of cold water, and then add half 
a pint of hot water, a pinch of salt, a tablespoonful of sugar 
and a little grated lemon peel; boil gently fifteen minutes, 
stirring constantly. A little port wine or sherry may be 
added just before removing from the fire. 

May be served hot or cold. 



DIETARY. 173 

TAPIOCA. 

Wash two tablespoonfuls of the best tapioca ; soak in 
fresh water over night ; add a little salt, a pint of milk or 
water, and simmer until quite soft, stirring frequently if milk 
be used ; then pour into a bowl and stir while cooling, at 
the same time adding sugar, some flavoring substance and 
wine if required. 

TAPIOCA PUDDING. 

Beat the yelks of two eggs with half an ounce of sugar ; 
stir into a pint of tapioca mucilage made with milk, as 
directed above, and bake in a slow oven. 

EGG-AND-BRANDY. 

Brandy 8 tablespoonfuls. 

Cinnamon water 8 tablespoonfuls. 

The yelks of two eggs. 

White sugar I tablespoonful. 

Rub the yelks and sugar together; then add the cinnamon 
water and spirit. 

A dessertspoonful to two tablespoonfuls may be given 
every two hours, according to the age of the child. 

WINE WHEY. 

Boil a pint of fresh milk ; while boiling, pour in eight 
tablespoonfuls of sherry wine ; bring it to the boil a second 
time, being careful not to stir it ; so soon as it boils, put it 
aside until the curd settles, and pour off the clear whey. 

FLAXSEED TEA. 

Whole flaxseed I ounce. 

Bruised licorice root 2 teaspoonfuls. 

Water, boiling I pint. 

Pour the boiling water over the flaxseed and licorice 



174 HYGIENE OF THE NURSERY. 

cover lightly ; digest for three hours near a fire, and strain. 
Two tablespoonfuls of lemon juice may be used as the flavor, 
instead of the licorice. 

The following preparations are useful as additions to milk 
in bottle feeding : — 

CARAWAY WATER. 

Caraway seeds, crushed 2 tablespoonfuls. 

Water I pint. 

Enclose the seeds in a small muslin bag, and boil in the 
water until the latter is reduced to half a pint. 

One or two teaspoonfuls may be added to the bottle in 
case there be colic. 

BARLEY WATER. 

Put two teaspoonfuls of washed pearl barley into a sauce- 
pan with a pint of clear water, and boil slowly down to two- 
thirds of a pint ; strain through muslin. 

Employed to prevent the formation of large, compact 
curds. 

GELATINE. 

Put a piece of plate gelatine, an inch square, into half a 
tumblerful of cold water, and let it stand for three hours ; 
then turn the whole into a teacup, place this in a saucepan 
half full of water, and boil until the gelatine is dissolved. 
When cold, this forms into jelly. 

From one to two teaspoonfuls may be added to each 
bottle of milk food. 

Employed for same object as the above. 

FLOUR BALL. 

Take a pound of good wheat flour — unbolted, if possible 
— tie it up very tightly in a strong pudding-bag ; place it in 
a saucepan of water and boil constantly for ten hours ; 
when cold remove the cloth ; cut away the soft outer cover- 



DIETARY. 175 

ing of dough that has, been formed, and reduce the hard, 
baked interior by grating. 

In the yellowish-white powder obtained, almost all the 
starch has been converted into dextrine by the process of 
cooking, and the proportion of the nitrogenous principle to 
the calorifacient is as one to five — nearly the same as in 
human milk. 

This acts both mechanically and as a food. 

LIME WATER. 

Take a piece of unslaked lime as large as a walnut; 
drop it into two quarts of filtered water contained in an 
earthen vessel ; stir thoroughly ; allow to settle, and use 
only from the top ; replacing the water and stirring as con- 
sumed. 

OATMEAL WATER. 

First prepare an oatmeal porridge ; take a heaping tea- 
spoonful of this, put it into a quart of cool water, heat with 
constant stirring, to the boiling point, and strain. 

This may be used in milk-foods as a substitute for ordi- 
nary water if constipation be present. 

PEARL BARLEY JELLY. 

Put two tablespoonfuls of washed pearl barley into a quart 
saucepan with a pint and a half of clear water and boil 
slowly down to a pint ; strain, and allow the liquid to set 
into a jelly. 

Used for same purpose as barley water. 

RICE WATER. 

Put two tablespoonfuls of rice, thoroughly washed, into a 
quart of water and place near the fire, where it may soak 



1^6 HYGIENE OF THE NURSERY. 

and be kept warm for two hours ; then boil slowly for one 
hour, or until the water is reduced one-half, and strain. 
Useful as a diluent for milk in cases of diarrhoea. 



WHEY. 

Milk 1 pint. 

Essence of pepsin .......... 2 teaspoonfuls. 

Heat the milk up to a point that can be agreeably borne 
by the mouth, and add the pepsin with gentle stirring ; let 
the whole stand until firm coagulation has taken place; then 
beat with a fork until the curd is finely divided, and strain. 

NUTRITIOUS ENEMATA. 

The process of peptonization, already described, is very 
useful in the preparation of food for absorption by the lining 
membrane of the rectum. Any of the predigested foods 
may be used in this way, the only caution being to admin- 
ister them in small quantities — not over four tablespoonfuls 
— and at intervals of not less than four hours. It is essential, 
too, in rectal alimentation to keep the lower bowel clear by 
a daily laxative injection of warm water. 

When the materials for proper peptonizing are not at 
hand, one of the following enemata may be used with 
advantage in the interim : — 

MEAT ENEMA WITH PEPSIN. 

Essence of meat, No. 2 8 tablespoonfuls. 

Gelatine (page 174) 1 tablespoonful. 

Pepsin 4 grains. 

Muriatic acid 4 drops. 

First mix the essence and gelatine, and warm in a water 
bath at 11 2° F. ; then dissolve the pepsin in a teaspoonful 



DIETARY. 



I// 



Fig. 18. 



of warm water by the aid of the acid ; stir it into the first 
mixture and let the whole remain warm for 
two hours. 

Administer warm with two drops of 
laudanum to secure retention. 

The bulk of this enema is adapted for a 
child of eight or twelve years. 

BEEF-TEA AND BRANDY ENEMA. 

Strong beef tea 3 tablespoonfuls. 

Cream I teaspoonful. 

Brandy I teaspoonful. 

Stir all together, and administer gently 
and slowly. 

Should this injection not be retained, 
add two drops of laudanum at each ad- 
ministration. The best syringe for these 
injections is shown in Fig. 18. 




SYRINGE FOR NUTRI- 
TIOUS ENEMATA. 



yS HYGIENE OF THE NURSERY. 



CHAPTER X. 

EMERGENCIES. 

In the first Chapter, attention was directed to certain 
deviations from the features of health that should lead the 
mother or nurse to suspect the onset of disease. In addi- 
tion to these, it is of great service to take into account the 
four seasons of the year, and to be informed of what dis- 
eases are most apt to prevail during each. 

In the late fall and early winter catarrhal affections are 
common. In catarrh there is an increased secretion of 
mucus from the lining membrane of either the nose, the 
throat, the air-tubes or the digestive canal, attended by 
fever, loss of appetite, thirst and lassitude, with sneezing, 
hoarseness, cough, vomiting or diarrhoea, according to the 
situation of the disease. 

As winter advances, the bronchial tubes, the lungs them- 
selves and their investing membrane — the pleurae — are liable 
to attack, and the signs of bronchitis, pneumonia or pleurisy 
to be developed. 

In the changeable weather of spring, together with the 
catarrhal and inflammatory disorders already mentioned, 
epidemics of measles, scarlet fever and chicken pox are 
most prevalent ; while during the summer months, dis- 
orders of the bowels, such as diarrhoea, summer com- 
plaint and cholera infantum, swell the mortality lists of 
the larger cities. 

Again, the influence of any hereditary tendency to dis- 
ease should always be present in the mother's mind, as this 
not only makes her alive to the possibility of the onset of 



EMERGENCIES. 1 79 

illness and leads her to seek medical advice in time, but 
also induces her to anxiously shield her child from known 
exciting causes, and to adopt hygienic measures calculated 
to overcome the constitutional predisposition. 

In considering the question of emergencies, under which 
term will be included both accidents and certain conditions of 
disease, no reference will be made to the management of 
serious disorders, for these, even in their earliest stages, 
must receive the attention of a physician. 



ACCIDENTS AND DISORDERS OCCURRING AT BIRTH OR SOON 

AFTER. 

INJURIES RECEIVED DURING BIRTH. 

The shape of the head is sometimes altered by the 
compression it is subjected to during a prolonged and 
difficult labor. The deformity is usually in the direction 
of elongation. The distance from the chin to the back 
of the head at times measuring six inches or even more. 
There is no ground for apprehension in these cases, and 
the head will regain its natural shape without mechanical 
interference. 

Swellings upon the scalp are quite common. They are 
due to pressure sustained by the parts in labor. Such tumors 
gradually subside, if kept free from compression and fre- 
quently bathed with cooling lotions; of the latter, alcohol 
and water, the extract of witch-hazel and water, or diluted 
lead water are serviceable. 

The face may be congested and blackened and the features 
disfigured and distorted from the same cause. A natural 
appearance, however, will be recovered in a few days without 
any treatment. 



l80 HYGIENE OF THE NURSERY. 

BLEEDING FROM THE NAVEL STRING. 

This serious accident occasionally occurs some hours after 
birth. It arises from the cord being carelessly tied or from 
its being unusually large at birth, and subsequently shrinking 
so that the ligature ceases to close the blood vessels. 

To arrest the hemorrhage, the infant's clothes and flannel 
binder must be removed and the cord exposed ; then a new 
ligature, composed of six strands of strong linen thread, 
must be applied half an inch nearer the body than the origi- 
nal one, and tied tight enough to compress thoroughly the 
vessels, but not so tight as to cut through the cord. 

ULCERATION OF THE NAVEL. 

The cord generally separates from the navel between the 
fifth and fifteenth day after delivery, and the parts should 
then heal without trouble. Occasionally, after the falling 
of the cord a small growth, about as large as a pea, appears 
on the navel, giving rise to a discharge of thin liquid. This 
may be relieved by applying a little powdered alum and 
afterward dressing with vaseline or oxide of zinc ointment. 

Again, though rarely, excoriation of the navel and sur- 
rounding skin takes place, and rapidly spreads, assuming 
an inflammatory character. The attention of the physician 
must be called to this. Apply a warm water dressing should 
his visit be delayed. 

SECONDARY BLEEDING FROM THE NAVEL. 

At the time of, or several days after, the separation of the 
cord, bleeding may take place from the navel. In this event, 
which is fortunately uncommon, place the point of the finger 
over the part and steadily, but gently, press it until medical 
aid can be obtained. 



EMERGENCIES. I 8 I 

When a bleeding growth appears at the navel wind a 
piece of very narrow tape closely around it and leave the 
whole undisturbed. Under these circumstances the hemor- 
rhage quickly stops and the growth soon sprouts over the 
upper edge of the tape and, strangulating itself, drops off. 

YELLOW STAINING OF THE SKIN. 

During the first few days of life, especially after a difficult 
and tedious birth, there is apt to be intense congestion of 
the skin, followed, as the redness fades, by a brownish-yellow 
discoloration. This usually disappears by the tenth day. 
The coloration resembles that of true jaundice, but there is 
no yellow staining of the whites of the eyes, nor change in 
the color of the urine or faeces. Real jaundice occasionally 
occurs and is a serious condition, requiring careful manage- 
ment. 

RETENTION OF URINE AND FAECES. 

Infants frequently do not pass urine for many hours after 
birth. Sometimes not for days. This maybe due to complete 
want of secretion or to some temporary engorgement of 
the kidneys, which can be relieved by drawing the blood to 
the surface by immersion in a warm bath ; a procedure to 
be adopted in all cases in which no urine is voided during 
the first twenty-four hours of life. Often, in lieu of the bath, 
it will suffice to lay a piece of flannel, wrung out of hot 
water, upon the lower third of the abdomen — the region 
over the bladder. 

Occasionally some physical malformation leads to reten- 
tion of urine, and it is the duty of the nurse to be on the 
lookout, so that she may early call the physician's attention 
to the matter. The same condition may also prevail in the 
bowel, and when twelve hours elapse without any evacuation 
the parts ought to be carefully examined. 



1 82 HYGIENE OF THE NURSERY. 

SWELLING OF THE BREASTS. 

At birth, or within the following day or two, the mam- 
mary glands of an infant may swell, become hard and 
painful, and secrete a thin fluid much resembling milk. 
Never make any pressure to remove the secretion, as it may 
lead to inflammation. Judicious inaction is best when the 
swelling is moderate, and the constant application of a hot- 
water dressing in severer cases, when the surface is red, 
and the parts much swollen, and hard and tender to the 
touch. 

INFLAMMATION OF THE EYES. 

This is a most important condition, and, from the outset, 
requires the attention of the physician and the greatest care 
on the part of the nurse. 

The inflammation usually comes on about three days after 
birth, in the following manner : — on waking from sleep, the 
child's eyelids are slightly glued together ; their edges, par- 
ticularly at the corners, are redder than is natural, and on 
turning down the lower lid a little white matter will be ob- 
served on the inside. Light causes pain and there is a ten- 
dency to keep the eyelids closed. After a short time the 
lids swell, become red on their external surfaces, and a large 
quantity of matter is secreted and constantly pours from the 
eye. Apart from pure medicinal treatment, the nurse must 
keep the eye free from discharge by constantly washing away 
the matter secreted. Burn the rags or cotton used in this 
process at once, and it is most important for the attendant 
not to carry any of the discharge to her own eyes. 

HARE-LIP AND CLEFT-PALATE. 

These are deformities requiring the attention of the sur- 
geon, and under ordinary circumstances his aid should, in 
case of simple hare-lip, be sought within the first six months 



EMERGENCIES. 



183 



Fig. 19. 



of the child's life, so that the operation may be well over 
before dentition begins. The fourth month is the period 
of election, but should there be difficulty in sucking and 
any evidences of inanition, the operation may be performed 
at an earlier age. The operation for cleft-palate should not 
be undertaken before the end of the second year. 

So far as the mother is concerned, the question of import- 
ance is whether or not there is any interference with the 
act of sucking. If hare-lip be trifling, the infant will be 
able to suck, provided the mother's nip- 
ple be large and the milk flow freely; 
when the reverse is the case, resort to 
a nipple shield. In grave cases, espe- 
cially when hare-lip is associated with 
cleft-palate, the child is unable to suck 
either from the breast or from the 
bottle, and must be fed from a spoon. 
Occasionally one can succeed in feeding 
a child so affected from a bottle, by 
resorting to a false palate. This con- 
sists of a bit of thin india-rubber, cut 
the size and shape of the roof of the 
mouth and fastened by several firm 
stitches to an ordinary bottle tip (see Fig. 19). In using 
this instrument, the nurse must insert it into the mouth 
in such a way, that the rubber diaphragm will come upper- 
most and bridge over the imperfect portion of the palate. 




TIP WITH FALSE PALATE. 



TONGUE-TIE. 

In this condition the bridle beneath the tongue is either 
too short, or is attached so near the tip of the tongue as to 
interfere, at first, with the movements of the organ in suck- 
ing, and, afterward, in speaking. Although frequently sus- 



1 34 HYGIENE OF THE NURSERY. 

pected, it, in reality, occurs very rarely. The best way to 
determine if tongue-tie exist or not, is to watch whether 
the infant can protrude the tip of the tongue beyond the 
lips. If so, it will be able to suck a good nipple readily, 
and nothing need, nor ought, to be done. Should the re- 
verse condition prevail, it will be necessary to nick the bridle, 
and, as there is considerable danger of hemorrhage in this 
operation, a surgeon must always be consulted. 



ACCIDENTS AND DISORDERS OCCURRING IN INFANCY AND 
CHILDHOOD. 

BRUISES. 

A contusion or bruise must be treated as soon as received, 

if one would relieve pain, lessen swelling and prevent the 

formation of a black and blue spot. Compresses wet with 

hot water, a light ice bag,* or a lotion of fluid extract of 

witch hazel, are the best remedies. A bruise upon the head 

in the case of a young infant, and especially when followed 

by paleness and vomiting, is not to be carelessly overlooked, 

since it is sometimes the origin of convulsions. 

SPRAINS. 

Do not make light of a severe sprain, for the consequences 
are often more lasting than those of a broken bone. 

Much care and patience will be required in the manage- 
ment of sprains, the great point being to secure rest for the 
injured part. Should the knee or ankle joint be involved, 
put the patient to bed and swathe the part in a hot- water 

* Heat and cold act in the same way upon the blood vessels, contracting 
them and preventing the transudation of blood. It is the changes occurring 
in the latter after leaving the vessels that produce the discoloration. 



EMERGENCIES. 1 85 

dressing, or in compresses soaked with arnica or fluid extract 
of witch-hazel. When a joint of the upper extremity is 
involved, it is, of course, unnecessary to confine the child 
to bed; but at the same time the limb must be placed in 
such a position as to be as quiet as possible, while the local 
applications already mentioned should be employed. Later 
passive motion must be practiced in order to prevent per- 
manent stiffness. A sprain, however, needs the surgeon's 
attention as much as a broken bone. 



FRACTURES. 

The breaking of a bone is indicated by deformity of the 
limb, such as bending, shortening or twisting, and when this 
occurs, much suffering to the patient and injury to the part 
may be saved by a little careful management. In lifting the 
child from the spot where the accident happens and carry- 
ing him to a bed, it should be one person's duty to support 
tenderly the injured limb, instead of allowing it to dangle 
loosely. Once in bed, lay this upon a soft, rather broad 
pillow, double around the limb, and tie up tightly so as to 
afford protection from jars or shaking. 

Beyond this, nothing should be done until the physician 
arrives, except preparation of the bed in case of fracture of 
the lower extremity. This preparation consists in arranging 
a firm, though not too hard, mattress, with two or three 
under blankets for the sake of warmth. 



CUTS. 

These may be clean, as when made by a knife ; torn, by 
a broken plate ; or abraded, by a fall on hard, rough ground. 
If large and deep, the surgeon should be called at once. In 
trifling cases, the nurse must first thoroughly cleanse the 



1 86 HYGIENE OF THE NURSERY. 

wound by sponging it with hot water, and check the flow 
of blood by pressure, by the application of hot water, or 
should the hemorrhage be obstinate, by the use of a solution 
of alum. In the case of a knife cut, the next step is to press 
the edges together and fix them in this position by applying 
a number of narrow strips of surgeon's adhesive plaster at 
short intervals across the wound. A torn wound may be 
dressed in the same way, but greater care is required to 
coadapt the edges. For abrasions, the best application is a 
piece of lint covered with vaseline or other bland ointment. 
The plaster dressings need not be changed until the strips 
become loose, but the lint and vaseline may be changed 
twice a day. When an artery is cut, the flow of blood must 
be checked by pressure on the vessel above the seat of 
injury; in the case of a vein, below it. Arterial blood flows 
in jets and is scarlet ; venous blood runs in a continuous 
stream and is purple in color. 

BURNS AND SCALDS. 

The danger from burns or scalds is in direct propor- 
tion to the extent of surface involved and the depth of 
tissue destroyed. Fortunately, the majority of cases are 
trifling, and usually the hands or face are the parts that 
suffer. In these instances there are two things to be done ; 
first, to relieve pain, and secondly, to encourage healing. 
To accomplish the former, a saturated solution of baking 
soda ; for the latter use some mild ointment — fresh lard, for 
example — and keep the injured part protected from the air 
by a dressing of cotton batting. 

Should the child's clothing take fire, remember that an 
upright position not only favors the spread of the flames, 
but encourages their approach to the neck and head. Any 
movement of the body, too, aids the flames by bringing 



' EMERGENCIES. 1 87 

fresh currents of air in contact with the burning materials. 
Therefore, do not let the child run about, but seize him, 
throw him down upon the floor and envelop his body 
closely in the hearth rug or a woolen table cloth. 

Should the child have fallen into a tub of scalding water, 
remove him immediately and undress him. In taking off the 
clothing, be careful to do it so gently as not to break the 
blisters produced by the moist heat, and should the under- 
clothing stick anywhere to the surface, the garments must 
be cut away piecemeal, leaving the adherent portions un- 
touched. 

Afterthe above preliminaries he must, in either case, be put 
at once to bed. Next prepare a number of pieces of old muslin 
corresponding in size with the injured areas, smear these 
with fresh lard or cosmoline, apply them and cover all with 
a thick layer of cotton batting. Should the patient com- 
plain of cold hands or feet, or of faintness, a little whisky or 
brandy may be administered and artificial heat applied to 
the extremities if these be uninjured. Nothing else should 
be done without the physician. 

STINGS OF INSECTS. 

Children, being more ignorant, are more frequently stung 
by bees, wasps, and other insects, than adults. Examine 
the wound the first thing with a magnifying glass, and if 
the sting be still in the tissues, extract it with a pair of 
tweezers, or squeeze it out by firm pressure in the neighbor- 
hood of the puncture. After this apply aromatic spirits of 
ammonia or eau de Cologne. These will relieve the pain 
and itching. When the sting produces great pain and 
inflammation, apply a flaxseed poultice for twenty-four hours. 
The frequent use, afterward, of camphorated soap liniment 
will be productive of good results. 



155 HYGIENE OF THE NURSERY. 

FOREIGN BODIES IN THE EAR. 

When a foreign substance has entered the ear, the plan 
for its extraction depends somewhat on the nature of the 
material. In any case, however, bend the child's head to- 
ward the affected side, cause him to open his mouth as wide 
as possible, and at the same time gently pull the external 
ear upward and backward. In this way the external canal 
of the ear is straightened and stretched to its widest extent, 
and a small body like a bead may drop out. Another 
method is to wash the foreign body away with warm water 
and a syringe. Should the substance be of a nature to 
increase in size by absorbing moisture, such as a pea or 
bean, its extraction must be left for the physician, though it 
is to be delayed no longer than absolutely necessary. When 
an insect enters the ear, the external canal must at once be 
filled with fresh olive oil. 

FOREIGN BODIES IN THE EYE. 

A simple plan for removing cinders and the like from 
the eye is to pull the upper eyelid forward and downward, 
by grasping the eyelashes, and direct the child to look 
upward. In this way the lashes of the lower lid are made 
to sweep over the inside of the upper one, and thus may 
brush away the foreign body. If this be unsuccessful, and 
if the offending substance be in sight, remove it with the 
corner of a fine handkerchief; but, if not seen on the eye- 
ball, it must be looked for beneath the lids. It is easy enough 
to pull down the lower lid and examine its internal surface; 
in case of the upper lid, however, it is necessary to perform 
eversion ; this is done by drawing the lid downward and 
forward, and turning it over a thin lead pencil. (Fig. 20.) 
Direct the child, in the meanwhile, to look down. When 
the intruding body is disclosed by this process, it may be 



EMERGENCIES. 



brushed away by a little cotton twisted upon the end of a 
match stick ; the touch must be very gentle, and no pro- 
longed effort made if the mote be imbedded. Treat any 



Fig. 20. 




METHOD OF EVERTING UPPER EYELID. 



slight irritation following this accident and the process of 
removal by frequent applications of hot water. 

FOREIGN BODIES IN THE NOSE. 

Children frequently insert shoe buttons, peas, beans, and 
other small objects into the nose. When these are not too 
firmly fixed, or have not been pushed too far up, they may 
be removed by closing the opposite nostril and causing the 
child to blow his nose forcibly. Another way is to stretch 
the orifice of the nostril, and, having made a blunt hook by 
bending the upper part of a hair-pin sidewise, pass this up 
and over the object and gently extract it. Should any 
difficulty be experienced, it is better to consult a physician 
than use persistent force. 



FOREIGN BODIES IN THE THROAT. 

A large, unchewed mass of food, a fish bone, or some 
metallic substance, as a piece of money, may become 
lodged at some point in the throat. 



I9O HYGIENE OF THE NURSERY. 

When this occurs, immediately insert the finger and 
thumb into the mouth, pass them as far down the gullet as 
possible, and if any object be felt make an attempt to pull 
it forth. 

Instead of lodging in the upper part of the gullet, the 
foreign body may be arrested midway in its course to the 
stomach. Let the child then partially masticate and swal- 
low a piece of bread and several mouthfuls of water, which 
will probably assist the object's passage into the stomach ; 
if not, medical skill will be required. 

Foreign bodies, such as buttons and coins, that pass 
directly into the stomach give rise to little trouble, and soon 
find their way through the alimentary canal, and are voided 
from the rectum with the ordinary faecal evacuations. Laxa- 
tive medicines are never needed unless the bowels be 
absolutely confined, and then moderate doses of castor oil 
are the most suitable. 

BLEEDING FROM THE NOSE. 

Hemorrhage from the nose is sometimes so excessive as 
to lead to debility, or even threaten serious results. An 
injury or abrasion of the lining mucous membrane is the 
usual cause of hemorrhage, though it may result from cer- 
tain constitutional conditions. To arrest the bleeding, put the 
child upon abed, with the head and shoulders well elevated. 
First make pressure, with the thumb and index finger, on the 
root of the nose, i. e., that portion between the eyes, or on 
either side of the nostrils where the blood vessels, ascending 
from the lip, are felt to pulsate. Should this fail, after a 
reasonable time, plug the nostril from which the blood 
flows with a cone-shaped pledget of absorbent cotton or lint ; 
this may either be dry or saturated with a solution of alum 
and water as hot as can be borne. The inhalation of the 



EMERGENCIES. I9I 

vapor of spirits of turpentine, or the immersion of the feet 
and legs in a hot mustard foot bath, are each successful in 
some cases. If the bleeding be obstinate, apply a piece of 
ice wrapped in flannel to the forehead or the back of the 
neck. 

EAR-ACHE. 

Ear-ache is a very common cause of crying in infancy and 
childhood. Screaming from ear-ache may be distinguished 
from that due to pain in the bowels, another fruitful source 
of crying, by the former being more continuous, and by 
the child frequently carrying his hand to his head ; again, 
in ear-ache the passages from the bowels are natural, while 
in bowel-ache they are usually altered in character and 
offensive. 

Put into the ear, for a short distance, a small piece of 
absorbent cotton saturated with a small quantity of olive 
oil containing a few drops of laudanum, or, better still, with 
a two per cent, solution of cocaine ; at the same time dry 
or moist heat may be applied to the external ear. 



VOMITING. 

The most healthy infants, even though they be fed at a 
normal breast, often expel a portion of each feeding. This 
is an act of regurgitation rather than vomiting, and is, in 
reality, a natural method of relieving an over-burdened 
stomach. 

Vomiting proper is preceded by the sensation of nausea; 
is followed by lassitude, and is often attended by fever. It 
indicates some disorder of the stomach. For its relief, per- 
fect rest for the whole body; several hours' starvation, or rest 
for the stomach, and a reduction in the quantity and strength 
of the food, are necessary. Bits of ice, soda-mint, lime 



I92 HYGIENE OF THE NURSERY. 

water, and a mixture of equal quantities of cinnamon water 
and lime water, in teaspoonful doses, are simple and efficient 
remedies ; a weak mustard plaster placed upon the pit of 
the stomach is always useful. Should the symptom be 
obstinate, however, the case becomes too serious for the 
mother to manage on her own responsibility. 

COLIC. 

Colic is a very common affection of infancy. It usually 
occurs in the period between birth and the end of the third 
month, and gives rise to much discomfort, both to the infant 
and its attendants, by causing fretfulness, crying and wake- 
fulness. The treatment is very much one of diet and pro- 
perly prescribed drugs. Still, there are some domestic 
remedies which may be used safely and with success. Thus, 
the body should be anointed twice a day with warm olive 
oil and enveloped in a broad flannel binder. It is even 
more important to keep the feet warm, and for this purpose 
thick socks or long woolen stockings should be worn, and, 
in bad cases, artificial heat must be applied by hot water 
bottles. Medicines are indicated chiefly during attacks of 
pain. A serviceable prescription is ten drops of gin in a 
teaspoonful of sweetened warm water, or a small teaspoon- 
ful of hot soda mint. It is also well to administer a tea- 
spoonful of caraway water after each nursing, or with each 
bottle of food. 

When a paroxysm of pain is violent enough to lead to 
depression of the fontanelle and threaten collapse, place the 
infant in a warm bath for five minutes ; after removing and 
carefully drying him, wrap him in a blanket ; put a flax- 
seed poultice with a dash of mustard over the abdomen ; 
apply a hot water bottle to the feet ; relieve the bowels by 
an enema of warm water, and by the mouth give him ten 



EMERGENCIES. 1 93 

drops of gin or brandy in warm water. If the fontanelle 
still remain depressed, continue the stimulant in doses and 
at intervals proportioned to the urgency of the symptoms. 

CONSTIPATION. 

Habitual constipation is such a common occurrence in 
infancy and childhood that it warrants a somewhat detailed 
consideration. The methods that may be safely employed 
to clear the lower bowel of accumulated faeces, or, in other 
words, to relieve the actual state of constipation, will be first 
noticed, for this is always a necessary step when there is 
painful straining, and in case there has been no movement 
for a day or more. For this purpose injections are most 
efficient, and when given with care, are entirely free from 
danger. 

A serviceable plan is to inject into the rectum, according 
to the age of the patient, from one to four teaspoonfuls of 
warm olive oil ; allow it to remain for six hours, and then 
use one or more injections of castile soap and warm water, 
olive oil, soap and warm water, or table salt and warm 
water. The preliminary injection of oil softens the faeces, 
while the subsequent ones have the additional effect of dis- 
tending the walls of the rectum, thus bringing about mus- 
cular contraction and expulsion of its contents Should a 
compact faecal mass be present at the anus and be too bulky 
to escape— a condition often visible during straining — more 
liquid must be injected, and if this fail the mass must be 
broken up by the finger and its passage assisted by gentle 
pressure upon the parts behind the anus while expulsive 
efforts are being made. The process of breaking up is 
easy, as the anus is widely distended at such times. In 
obstinate cases little result may follow a single adminis- 
tration of the injections, though a course of one or two oil 
13 



194 HYGIENE OF THE NURSERY. 

injections and purgative enemata for several successive days 
rarely fails to empty the bowel. 

The best syringe for children is one of hard rubber with 
a long, smooth nozzle, having a capacity of six fluidounces. 
When oil is injected, the intention being to have it remain 
in the rectum and act mechanically on the faeces, its reten- 
tion is best secured by firmly pressing a warmed pad of 
flannel against the anus for five minutes after the insertion, 
the patient, in the meanwhile, lying upon his back. The 
laxative enemata must vary in bulk with the age of the 
child, or, in other words, with the capacity of the rectum ; 
one fluidounce (two tablespoonfuls) will be sufficient for an 
infant of six weeks, while from four to six fluidounces are 
required at the age of two years. The quantity of oil, salt, 
or soap to be used must depend upon the quantity of water 
—two teaspoonfuls of oil or one teaspoonful of salt to eight 
tablespoonfuls of water being a good proportion, and if soap 
be employed, it is sufficient to stir a bit in the water until 
suds begin to form. After drawing the fluid, which must 
be tepid, into the syringe, grease the nozzle well and gently 
insert it into the anus, directing the point a little toward the 
patient's left ; next, slowly force down the piston until all 
the liquid is expelled or complaints of pain indicate that 
the bowel is sufficiently distended. If it be possible to 
force retention for a moment or two by pressure on the 
anus, the movement will be freer and easier than if the fluid 
be allowed to flow away at once. The best positions for the 
child are either on his back with his legs well drawn up, 
or resting on his abdomen across the nurse's lap. 

For the prevention of further constipation the diet must 
be regulated according to the rules given in Chapter vin, 
and besides regulating the food and hours for meals, bath- 



EMERGENCIES. 1 95 

ing, sleep, exercise and clothing, care must be taken to 
establish fixed habits of defecation. 

In my experience the youngest infant can be taught to 
use a chamber. And if this vessel be presented each 
day at the same hour he soon falls into regular ways. 
Should faulty habits be established, or constipation exist, 
to establish regularity resort to such measures as injections, 
and abdominal massage at the same hour each day. 

After the third year the best period of the day for the 
bowels to be moved is immediately after breakfast, and no 
call of duty or pleasure should be allowed to interfere. 
When constipation is to be overcome natural efforts must 
be made then. These efforts may at first be ineffectual, but 
much can be accomplished by perseverance in a daily, sus- 
tained effort, for about ten minutes. When this plan fails, 
use injections or other methods of relief, taking care to keep 
to a certain hour, that the formation of a habit may be 
encouraged. 

Thorough rubbing of the abdomen is often successful 
in inducing a movement of the bowels. This should be 
done with the palm of a well-warmed hand, gentle pressure 
being made, and the movements directed first from the brim 
of the pelvis on the right side upward to the rib margin, 
then across from the right to the left, and finally down- 
ward on the left side from the margins of the ribs to the 
brim of the pelvis again. Such manipulation excites peri- 
staltic action, and encourages the passage of the intestinal 
contents along the large bowel toward the anus. Ten 
minutes is quite long enough to continue the rubbing. The 
manipulation may be rendered more effective by using 
warm sweet oil, or a weak ammonia or turpentine liniment 
as an inunction. 

With children of six years and upward daily cold spong- 



I96 HYGIENE OF THE NURSERY. 

ings of the body, followed by frictions with a coarse towel 
until the surface is red, are very beneficial. 

Manna, phosphate of sodium, and soap suppositories are 
among the medicines that may be safely used in the nursery. 

Manna, as it imparts a sweet taste only, may be dissolved 
in the food, and given from the bottle as often as required ; 
a piece as big as a pea, once, twice or three times daily, will 
be sufficient for an infant of six months. 

Phosphate of sodium — an admirable laxative — can also be 
administered with the food ; five or ten grains, three times 
daily is the proper dose at the same age. 

Soap suppositories must vary in strength with the age. 
At two months one grain of soap to ten grains of cocoa- 



FlG. 21. 




SOAP STICK. 



butter is the proper proportion ; at one year the quantity of 
soap may be increased to five grains in each suppository, 
and so on. A substitute for soap suppositories may be 
prepared in the nursery, as follows : Cut from a bar of good 
castile soap a piece two inches long and half an inch thick. 
Scrape this into a cone, pointing one end like a sharpened 
pencil, but with a blunter point and more gradual slope; 
make it quite smooth by rubbing the surface with a wet 
rag (see Fig. 21). When the soap stick is used anoint 
the pointed end with vaseline and gently insert it into the 
rectum and keep it there until the action begins. It is not 
desirable to leave any fragments of soap in the rectum. 



EMERGENCIES. 1 97 

CONVULSIONS. 

Convulsions arise from so many diverse causes, that it is 
impossible to indicate more than what is to be done during 
the fit and prior to the arrival of the physician. 

When the attack comes on, the child must be undressed 
at once and plunged into a warm bath, containing enough 
mustard flour to stimulate the skin thoroughly, for five 
minutes. This usually restores consciousness and checks 
the muscular twitching. Should there be a distinct history of 
overloading of the stomach, give an emetic of ipecacuanha, 
and after this has operated, a purgative dose of castor oil. 
One or more doses of bromide of potassium, five to ten 
grains, according to the age, may be also safely given ; this 
salt must always be administered in solution. 



A CHILL. 

This is always a serious occurrence and warrants sending 
for the doctor. Before his arrival, put the child to bed, sur- 
round him with bottles containing hot water, place a mod- 
erately strong mustard plaster over the abdomen or over the 
region of the heart, and administer whiskey and hot water 
in small doses and at short intervals. 

The ailments of children do not so frequently begin with 
a chill, as do those of adults, but when it does occur, it is 
a more decided indication of the future gravity of the attack. 

FEVER. 

It is not my intention here to refer to the management of 
the essential fevers, for I hold that neither mother nor nurse 
is capable of managing them without professional assistance. 

The following table, however, of the features of the erup- 
tive fevers will answer some of the questions which so 



198 



HYGIENE OF THE NURSERY. 



frequently suggest themselves to the minds of anxious 
mothers : — 



ERUPTIVE FEVERS. 



1> 

a 

S5 


u- a 
00 

.2 J 
« 3 


in 
a 
fi 

O 
>> 

P 


O 
U M 

u 


T3 



c u5 

O u> 

Q 


11 

3 
«.2 
rf So 
aB 
M 
U 


Measles. 


10 to 14 

days. 


4th day of 
fever, or after 
72 hours' ill- 
ness. 


Small, dull, red 
pimples, appear- 
ing behind the 
ears and on face. 


On 7th day 
of fever. 


9 days. 


From sec- 
ond day, for 
exactly 3 
weeks. 


Scarlet 
Fever. 


2 to 7 days. 


2d day of 
fever, or after 
24 hours' ill- 
ness. 


General rosy 
blush appears 
first about neck 
and shoulders. 


On 5th day 
after fever. 


8 or 9 
days. 

(This does 
not include 
sequels.) 


Fourth 
day, for 6 or 
7 weeks. 


Typhoid 
Fever. 


10 to 14 

days. 


7 th to 14th 
day. 


Rose -colored, 
slightly elevated 
spots, few in 
number, chiefly 
on abdomen. 




14 to 21 
days. 


Not con- 
tagious. 


Chicken- 
pox. 


8 to 16 
days. 


2d day of 
fever, or after 
24 hours' ill- 
ness. 


Appears in 
crops on back 
and abdomen, 
small, red pap- 
ules rapidly 
passing into 
globular vesicles. 


Slight 
scabs f r m 
about 4th 
day of fever. 


4 or 7 
days. 


First day, 
f r two 
weeks. 


Small- 
pox. 


14 days. 


3d day of 
fever, or after 
48 hours' ill- 
ness. 


Small, hard, 
red pimples, be- 
coming vesicles, 
then pustules, ap- 
pearing first on 
face and neck. 


Scabs form 
on 9th or 
10th day of 
fe ve r , and 
fall off about 
the 14th. 


14 to 21 
days. 


First day, 
for about one 
month. 



It may be well to give a few directions as to the manage- 
ment of a fever in the absence of a physician. Every fever, 
whether it be due to a poison circulating in the blood or to 
a passing irritation of little or no moment, is attended by 
the following symptoms, namely : heat of skin, lassitude, 
loss of appetite, and thirst. When these features arise, the 



EMERGENCIES. 1 99 

mother must be on her guard and take steps to place her 
charge in the best possible condition. Give the child, the 
first thing, a mustard foot bath ; * then put him to bed with 
only sufficient covering to keep up a normal body temper- 
ature. Reduce the diet to the simplest possible basis, milk 
food being the safest. A moderate quantity of pure water, 
or of some effervescing saline water, and of ice, may be 
allowed. Febrifuges, as aconite, or even sweet spirits of 
nitre, had best not be given without advice, and quinine or 
other remedies are not to be trifled with. 

Should head-ache be severe, place cold compresses upon 
the forehead, or a weak mustard plaster (one part of mus- 
tard to six of flour) on the nape of the neck. 

Free urination should be encouraged by hot compresses 
over the bladder, and it usually does no harm to secure a 
free action of the bowels by a mild saline laxative. 

CONTAGIOUS DISEASES AND DISINFECTION. 

There are certain points connected with the nursing of 
contagious diseases and the subject of disinfection that are 
worthy of'mention. 

In every case of contagious disease, allow in the room 
only those who are necessary to nurse the sick. The nurse 
must avoid over-fatigue, have regular meals of digestible 
and nourishing food, and fixed hours for sleep and relaxa- 
tion. The chamber selected for the sick room should be 
large, well ventilated, and as near the top floor of the house 
as possible. Upholstered and stuffed furniture, curtains, 
hangings, carpet and other articles capable of holding dis- 
ease germs, are difficult to disinfect, and should be removed 
before the entrance of the patient; in fact, to put this matter 

* See page no. 



200 HYGIENE OF THE NURSERY. 

in a nutshell, the sick room should contain only such furni- 
ture as will be absolutely needed by the patient and nurse. 
Scrupulous cleanliness is essential. Remove dirty dishes, 
vessels with discharges, soiled napkins, and the like, at once. 

Disinfectants are substances that destroy the infective 
power of infectious materials, and must be confounded with 
neither antiseptics or arrestives of putrefaction, nor with 
deodorizers or neutralizers of bad smells. 

In the use of disinfectants, it is important to bear in mind 
that contagious virus must be destroyed at its source. As 
this, of course, is the body of the sick, all discharges must 
have their power for evil destroyed as soon as possible. 
Receive discharges from the mouth and nose, especially in 
cases of scarlet fever and diphtheria, in bits of rags, and 
burn them immediately after use. When the skin is affected, 
as in scarlet fever, for example, the flakes that fall away are 
highly infective. To prevent these becoming disseminated, 
the surface should be anointed several times a day with 
vaseline, lard or cocoa-butter, either of which substance will 
be rendered more efficient by the addition of carbolic acid 
(one part to forty). 

Articles used about the patient, such as sheets, pillow- 
cases, blankets and clothes, should not be removed from the 
chamber until they have been soaked for at least an hour in 
the following disinfecting fluid : — 

Sulphate of zinc . . . 8 ounces. 

Carbolic acid I ounce. 

Water 3 gallons. 

Place, after this, the soiled articles in boiling water for 
washing. 

Articles not requiring to be frequently changed, such as 
feather or hair pillows and mattresses, need fumigation. 
This may be accomplished at the termination of the case. 



EiMERGENCIES. 201 

Keep a small quantity of the above fluid in all vessels 
used for receiving the discharges of the patient, and, after 
being used, empty quickly and clean with boiling water. 
Water closets or privy wells in which these discharges are 
poured must also be disinfected each day with a solution of 
copperas (one pound to the gallon). 

Fumigate the sick room itself as soon as the patient 
leaves it. To do this, tightly close the room and stuff all 
apertures, such as keyholes, loose window sashes, spaces 
under doors and so on, with cotton or rags. Then place a 
quantity of roll sulphur,* broken into small fragments, in a 
saucer, standing either in a large iron kettle or supported 
by two bricks set in a tub partially filled with water. Next, 
sprinkle a little alcohol over the sulphur and apply a live 
coal, and as soon as combustion begins, leave the room, 
shutting the door of exit. The room must remain closed 
for at least twelve hours and then be thoroughly aired. 

Wood-work and walls, if painted, should be wiped down 
with a solution of chloride of lime (one ounce to the 
pint) or carbolic acid (one drachm to the pint), and then 
scrubbed with soap and hot water. Re-papering and fresh 
painting are advisable in cases of scarlet fever or smallpox. 

The person of the patient or nurse may be disinfected by 
washing with a two per cent, solution of carbolic acid.. 

Both milk and water will carry disease germs, and hence 
both must be thoroughly boiled when there is any danger 
of their being contaminated. Never give delicacies or 
articles of food that have stood in the sick room to other 
members of the household. 



* The quantity of sulphur required is three pounds for every thousand cubic 
feet of space. 



202 HYGIENE OF THE NURSERY. 

VARIOUS DRESSINGS. 
POULTICES. 

Poultices may be made with Indian meal, bread, starch, 
ground slippery elm, flax-seed meal, or, in fact, any mate- 
rial that will retain heat and moisture. Flax-seed meal is 
usually selected because it is bland and non-irritating; be- 
cause it contains considerable oil, which gives it great heat- 
retaining properties, and because it is cheap. 

All poultices should be large, from half an inch to an 
inch thick ; applied as hot as can be borne, and renewed as 
soon as cold. A covering of oil silk or thin rubber cloth is 
useful to prevent rapid cooling. 

FLAX-SEED POULTICE. 

Take a perfectly clean bowl, pour in the requisite quan- 
tity of boiling water, then add the flax-seed meal slowly, 
stirring continually with a large spoon, to prevent the 
formation of lumps, until it becomes stiff enough not to run 
freely, then spread between two layers of old muslin, fold- 
ing the edges over so as to avoid soiling the part to which 
it is applied. 

THE JACKET POULTICE. 

The jacket poultice, so often employed in cases of pneu- 
monia, requires some skill in its preparation. 

For a child from one to three years old, use about a 
pound of flax-seed meal in each poultice. 

Take a piece of muslin or a large towel long enough to 
go all around the patient's chest, and of sufficient width, 
when folded on itself, to extend from the collar bone to a 
few inches below the lower end of the breast bone. After 
the meal is properly mixed, spread it evenly over one entire 
half, lengthwise, of the cloth, which should then be folded 



EMERGENCIES. 203 

over. Place this around the chest, with the open edge up- 
ward, and fasten behind to prevent it from slipping down. 
It should be held up by a tape passing over each shoulder. 
Put this poultice on as hot as the nurse can tolerate it 
against her cheek ; cover with oil silk and renew every five 
or six hours. When the cool poultice is to be removed, have 
a fresh one ready for immediate application. 

BREAD POULTICE. 

Make a bread poultice by soaking a muslin bag filled 
with bread crumbs, for a few moments, in boiling water, then 
squeeze it gently between two towels until it does not 
drip. 

CHARCOAL POULTICE. 

The charcoal poultice is useful in foul and sloughing 
sores, and is prepared by incorporating some powdered 
charcoal with a flaxseed, an Indian meal or a bread poultice, 
and then sprinkling the surface with more charcoal. 



PLASTERS. 
MUSTARD PLASTER. 

These plasters are used for the purpose of making counter- 
irritation, and must be graduated in strength according to 
the tenderness of the skin and the end to be accomplished ; 
pure mustard is very irritating and will quickly blister the 
tender skin of a child. Flour is the ordinary diluent, and 
the strength of the plaster ordinarily ranges from one part 
of mustard to three, six, or even more parts of flour. 

In making the plaster, take one teaspoonful of mustard 
flour and add to it three teaspoonfuls of wheat flour ; mix 
them together thoroughly on a plate, and pour on as much 



204 HYGIENE OF THE NURSERY. 

hot water (never vinegar) as may be necessary to make a 
soft mass. Spread evenly over a piece of muslin. To prevent 
the mustard from adhering to the skin, place a piece of 
gauze or thin muslin over the surface of the plaster; turn 
down the edges as in poultices. 

Remove the plaster after the surface becomes quite red. 

SPICE PLASTER. 

Take equal parts of ground ginger, cloves, cinnamon, 
and allspice, and one-fourth part of cayenne pepper; mix 
the ingredients together on a plate, and put the whole 
into a flannel bag about as large as the hand, and wet with 
hot whiskey or alcohol. 

After the bag is filled it is better to quilt it, otherwise, as 
it is usually worn some length of time, the ingredients are 
apt to fall together in a lump. 

DRY, HEATED APPLICATIONS. 

Make a bag of thick flannel, somewhat larger than the 
part to be covered. Half fill it with hot bran, hops, chamo- 
mile flowers, or whatever is to be used. Apply to the part 
on which it is intended to act. Retain it there by a bandage. 
When the bag and contents become cooled, quickly remove, 
substituting a few thicknesses of hot flannel until the bag 
can again be heated by placing it on a tin plate in the oven, 
or by holding it over burning coals, being careful, of course, 
not to scorch it. 

COLD WATER DRESSING. 

Take a piece of old linen or muslin large enough to 
cover the affected part. Thoroughly wet with cold water. 
Keep constantly wet by re-dipping in the cold water, or by 
gently squeezing out a wet sponge on the cloth, so as to 



EMERGENCIES. 205 

keep it wet without dripping. The latter plan is the 
better, as it causes no disturbance of the parts beneath, an 
important consideration in many cases. 

HOT WATER DRESSING. 

The hot water Sressing is prepared in the same way as the 
above, substituting hot for cold water, and covering with 
oil-silk. 

FLANNEL DIPPED IN SPIRITS. 

Take a piece of old, soft flannel. Heat it before the fire. 
Then fold it into the size and shape required. Dip into hot 
water and wring it dry. While this is being done by 
one person, some one else should put some common 
whiskey into a shallow dish over the fire, and heat it, being 
careful that the whiskey does not catch on fire. As soon 
as thoroughly heated, dip the flannel into it and squeeze out 
any excess of spirits, which would merely drip away, to the 
annoyance of the patient. Have the surface exposed, and 
rapidly apply the flannels as hot as can be borne. Over 
this flannel place another piece which is dry and has been 
heated quite hot and folded like the first one. If desirable, 
a bandage may be brought around to secure them in posi- 
tion. As soon as the inner flannel, which was dipped in 
the whiskey, has become somewhat dry, another one should 
be prepared at once and applied in its stead. 

TURPENTINE STUPE. 

A turpentine stupe is made by wringing a piece of old 
flannel out of hot water and sprinkling a few drops of warm 
spirits of turpentine on it. It should be covered with oil- 
silk while applied, and removed when sufficient irritation of 
the surface is produced. 



NDEX 



Abdomen, depression of, 21. 

distention of, 20. 
Abdominal belt, 70. 

dispensing with, 80. 

massage, 195. 
Air, importance of fresh, 8j. 
Albumen, 129. 
Ammonia, 61. 
Amusements, 82. 
Analysis of cows' milk, 130. 

of human milk, 129. 

of peptonized milk, 146. 
Ankle, pressure about the, 78. 
Appetite, 30. 

loss of, 31. 
Applications, dry heated, 204. 
Apron, the bath, 100. 
Arms, movements of, 27. 
Arrowroot food, 159. 

pudding, 170. 
Asses' milk, 142. 

Atmospheric air, the amount required 
for each child, 51. 

B. 

Baby jumper, dangers of, 86. 

powder, 102. 
Baby's basket, the filling of, 68. 
Barley jelly, 175. 

and milk, 148. 

water, 147. 
Bath apron, 100. 

best hour for, 106. 

blanket, no. 

bran, in. 

cold, 108. 

cooled, 109. 

daily, 104, 105. 

hot, no. 

mode of giving, IOI. 



Bath, mustard, no. 

salt water, no. 

sea, 106. 

soda, in. 

temperature of, 98. 

thermometer, 99. 

towels, 100. 
Bathing, 96. 

rain water for, 98. 

suit, 107. 

utensils, 97. 
Bed coverings, 94. 

feather, 93. 

separate, 94. 

wetting the, 35. 
Beef essence, 167. 

juice (raw), 167. 

raw, 168. 

tea, 166. 

and brandy enema, 177. 
peptonized, 164. 
Beer, 158. 

Bicarbonate of sodium, 138. 
Bicycles, dangers of, 90. 
Binder, the, 70. 

Birth, injuries received during, 179. 
Blanc mange, 170. 
Bleeding from the navel string, 180. 

from the nose, 190. 
Body clothing, 70. 
Boiled milk, 142. 
Bone, deformities of, 82. 
Boots, rubber, 81. 
Bottle tip, 152. 
Braces, 88. 

Brain, " water on the," 20. 
Bran bath, III. 
Bread poultice, 203. 
Breast milk, quality of, 124. 

specific gravity of, 129. 
Breasts, swelling of, 182. 
Breathing, accelerated, 36. 



206 



INDEX. 



207 



Breathing, diminished frequency in, 

37- 
Broth, chicken, 169. 

mutton, 169. 

veal, 169. 
Bruises, 184. 
Burns and scalds, 186. 



C. 

Cans for milk, 155. 
Cap, close-fitting, 79. 
Capacity of stomach, 136. 
Caraway water, 174. 
Carbolic acid, 201. 
Carriage, proper kind of, 85. 
Caseine, 137. 

Castile soap, unscented, 99. 
Cereals, 134. 
Charcoal poultice, 203. 
Chavasse's milk food, 160. 
Cheyne-Stokes' respiration, 37. 
Chicken broth, 169. 

pox, 178. 
Child, position of, while being fed, 

153. 

Childhood, 156. 

definition of, 17. 
Children, scrofulous and consump- 
tive, 87. 
Chill, a, 197. 
Chloride of lime, 201. 
Cholera infantum, 155, 178. 
Cinchona, ferrated elixir of, 122. 
Clear brown soup, 168. 
Cleft palate, 182. 
Clinical thermometer, 39,40. 
Clothing, 67. 

airing of, 72. 

change of, 81. 

shortening of, 72. 

warmth of, 80. 
Cold bath, 108. 

cream, 102. 

pack, 109. 
Cold-water dressing, 204. 
Colds, 86. 
Colostrum, 114. 
Compresses, in. 
Condensed milk, 132, 142, 160. 
Consomme, 168. 



Constipation, 193. 

Contagious disease, 199. 

Convulsions, 197. 

Cooled bath, 109. 

Copperas, 201. 

Corsets, 88. 

Cows, care of, 154. 

Cows' milk, analysis of, 130. 

Creeping, 85. 

Crib, 93. 

Cry of hunger, colic, etc., 1 17. 

Crying, 28, 29. 

Cuts, 185. 

D. 

Defecation, fixed habits for, 195. 
Dentition, 45. 

abnormal, 46. 
delayed and difficult, 47. 
second, as a cause of ill health, 
48. 
Diagram showing relative stature 
from one to twenty two years, 
24. 
showing eruption of milk teeth, 
46. 
Diarrhoea, 23, 178. 
Diet at ten months, 1 19. 

during the first four weeks, 135. 
the first week, 139. 
tenth and eleventh months, 
141, 
from the second to the sixth 
week, 139. 
the sixth week to the end of 

two months, 139. 
the third to the sixth month, 

139. 

the seventh to the ninth 

month, 140. 
the twelfth to the eighteenth 

month, 148. 
eighteen months to two and 

a half years, 149. 
three and a half years up, 

157. 
up to three and a half years, 156. 
Dietary, 159. 
Diseases, contagious, 199. 
Dishes, made up, 158. 
Disinfection, etc., 200. 



208 INDEX. 

Douche, miniature, 101. 
Draughts, 90. 
Drawers, separable, 73. 
Dress, or slip, 71. 
night, 72, 81. 
Drinking, 29. 
Drowsiness, long-continued, 27. 



E. 

Ear-ache, 191. 
Ear, foreign bodies in, 188. 
Ears, water in, 101. 
Effervescing milk punch, 163. 
Egg and brandy, 173. 

yelk of, 141. 
Emergencies, 178. 
Enemata nutritious, 176. 
Eructation of milk, 32. 
Eruptive fevers, table of, 198. 
Essence of beef, 167. 
Evacuations, faecal, 32. 
Excoriations, 102. 
Exercise, the infant's first, 82, 83. 

out- door, 84. 
Eyes, change of color of the, 26. 

foreign bodies in the, 188. 

inflammation of the, 182. 

lividity of the lids, 20. 

squinting of the, 18. 
Eyelids, incomplete closure of, 18. 

twitching of, 18. 



Face, the, 18. 

congested or blackened, 1 79. 

earthy tinge of, 20. 
Faecal evacuations, general characters 

of, 33- 
Faeces, retention of, 181. 
Farinaceous food, 134. 
Fatigue, 121. 
Fauces, 44. 
Feeding, artificial, 126. 

constant, 117. 

from the maternal breast, 114. 

general rules for, 136. 

hand, success of, 151. 



Feeding with cup or spoon, 120. 

Fever, 197. 

Fevers, table of eruptive, 198. 

temperature of, 42. 

treatment of, 199. 
Feet, cold, 70. 

shape of, 85. 
Figure, the, 88. 
Filtered water, 158. 
Finger nails, care of, 112. 
Fireplace, open, 57. 
Fissure of nipples, 122. 
Flannel dipped in spirits, 205. 
Flaxseed tea, 173. 

poultice, 202. 
Flour ball, 140, 174. 
Fluidounce and drachm, 119. 
Fontanelle, conditions of, 20. 

when it should close, 26. 
Foreign bodies in the ear, 188. 

in the eye, 188. 

in the nose, 189. 

in the throat, 189. 
Food, 114. 

arrowroot, 159. 

Chavasse's milk, 161. 

farinaceous, 134. 

fermentation of, 117. 

fried, 158. 

milk, 159. 

milk sugar, 161. 

milk and white of egg, 161. 

quantity per diem, 135. 
Foods, peptonized, 161. 
Foot bath, mustard, 1 10. 
Fractures, 185. 
Fruits, 157. 
Fumigation, 201. 



G. 

Garments, method of fastening, 72. 
Gastric juice, 132. 
Gelatine, 174. 

and milk, 171. 
Goats' milk, 142. 
Graduate, glass, 153. 
Graduated nursing bottle, 151. 
Growth, 24. 
Gruel, oatmeal, 172. 

starch, 148. 



INDEX. 



209 



H. 

Habitual constipation, 193. 
Hair, change of color in, 26. 

falling out of, 1 13. 

oil, 112. 

washing of, 106. 
Hand, carrying of, to head or mouth, 
28. 

feeding, success of, 151. 

to insure success in, 128. 
Hard palate, 44. 
Hare-lip and cleft palate, 182. 
Hat, light straw, 79. 
Head, shape of, 19. 

after prolonged labor, 179. 

squareness of, 20. 

support of, 8^. 

washing of, 104. 

when it can be held erect, 25. 
Health, the features of, 17. 
Heat, furnace, 57. 
Hominy grits, 1 71. 
Horlick's Food, 138. 
Hot bath, no. 
Hot-water dressing, 205. 
Household cares, 121. 
Human milk, analysis of, 129. 

substitutes for, 130. 
Humanized milk, 164. 
Hunger, 30. 
Hydrocephalus, 20. 



Ice water, drinking when heated, 90. 
Infancy, definition of, 17. 
Infant, carriage for, S5. 

development of the, 21. 

drying of the, 10 1. 

fed upon condensed milk, 133. 

foods, 134. 

how to be taken out, 84. 

initial bath of, 97. 

overfed, 135. 

position of, while feeding, 153. 

rocking of, 94. 

the hardening of an, 84. 

the jolting of an, 83. 

when able to sit up, 26. 
creep, etc., 26. 
Inflammation of the eyes, 182. 

14 



Injection of olive oil. 193. 

position of child during, 194. 
Injuries received during birth, 179. 
Insects, stings of, 187. 



Jacket poultice, 202. 
Jelly, sago, 172. 
Junket, 120, 171. 



L. 

Lactation, 121. 

Lactometer, 131. 

Leggings, 79. 

Light, night, 52. 
e, saccharate 
water, 137, 175. 

Lips, lividity of, 20. 



M. 

Malt extract, 122. 

Mammary glands, inflammation of, 

123. 
Manna, 196. 
Manners, 88. 
Mattress, spring, 93. 
Meals, preparation of, 153. 

regularity of, 116. 
Measles, 178. 

Meat enema with pepsin, 176. 
Medicine closet, contents of, 56. 
Meigs' food, 143. 
Mellin's Food, 138, 147. 
Menstruation, recurrence of, 123. 
Milk and barley jelly, 148. 
and cinnamon, 160. 
and gelatine, 171. 
and oatmeal, 160. 
and white of egg food, 161. 
asses', 142. 
boiled, 142. 
breast, 124. 

examination of, 130. 
regulation of the flow of, 

116. 
scanty secretion of, 122. 
specific gravity of, 129. 



210 



INDEX. 



Milk, breast, substitutes for, 130. 

to ascertain the quantity 
sucked, 126. 

cows', 155. 

condensed, 132, 142, 160. 

goats', 142. 

gruel, 163. 

humanized, 164. 

keeping of, 155. 

mixed, 154. 

peptonized, 144, 162. 
analysis of, 146. 

poisoning, 156. 

predigested, 143. 

powder, peptogenic, 146. 

punch, 163. 

effervescing, 163. 

sound, 154. 

sugar, 137. 

teeth, 45. 

transportation of, 155. 
Mind, cultivation of, 89. 
Morals, general, 88. 
Mouth, examination of, 43. 

inflammation of, 45. 

mucous membrane of, 44. 
Mustard bath, no. 

plaster, 203. 
Mutton broth, 169. 



N. 

Nap, the morning, 92. 
Napkins, 69. 

dispensing with, 80. 
Navel string, 180. 
Newly-born infant, length, weight, 

etc., 21. 
Night dress, 72. 
Nipple, fissures of, 122. 

protector, 123. 
Nose, bleeding from the, 190. 

foreign bodies in the, 189. 

rubbing of the, 28. 
Nursery, 49. 

cleaning the, 60. 

floor of the, 53. 

furnishing of the, 53- 

heating of the, 56. 

height of ceiling of the, 52. 

lighting of the, 52. 



Nursery, night, 49. 

situation of the, 50. 

size of the, 51. 

temperature of the, 56. 

ventilation of the, 57. 

walls and ceiling, 54. 
Nurse-maid, 63. 

cleanliness of, 66. 

face of, 65. 

selections of, age, etc,, 64. 
Nursing bottle, graduated, 151. 
tip, 152. 

bottle tip, for cleft palate, 
183. 
Nutritious enemata, 176. 



O. 

Oatmeal gruel, 172. 

water, 175. 
Oral mucous membrane, 44. 
Overcoat, 81. 
Oyster soup, 170. 
Oysters, peptonized, 164. 
Oxide of zinc ointment, 102. 



P. 

Palate, hard and soft, 44. 
Pancreatin, 144. 
Passages, character of, ^^. 
Pearl barley jelly, 175. 
Peptogenic milk powder, 146. 
Peptonized beef tea, 164. 

food, 161. 

milk, 144, 162. 

milk gruel, 163. 

milk punch, 163. 

oysters, 164. 
Phosphate of sodium, 196. 
Pictures in nursery, 54. 
Pillow, the, 94. 
Plasters, mustard, 203. 

spice, 204. 
Piatt's chlorides, 61. 
Play, 90. 

Pleurisy and pneumonia, 178. 
Poultices, 202. 

jacket, 202. 
Powder, baby, 102. 
Predigested milk, 143. 



INDEX, 



211 



Pregnancy, occurrence of, 123. 
Prepared chalk, in. 
Protector, nipple, 123. 
Puberty, 104. 
Pudding, arrowroot, 170. 

rice, 120, 172. 

tapioca, 173. 
Pulse, the, 38, 39. 

R. 

Raw beef, 168. 

juice, 167. 
Reaction of cows' milk, 130. 

of human milk, 129. 
Rennet, 132. 
Respiration, 35. 

Retention of faeces and of urine, 181. 
Retiring, late, 93. 
Rice milk, 171. 

pudding, 120, 172. 

water, 175. 
Rickets, 27, 124. 
Riding, 87. 
Rising early, 92. 
Rocking baby to sleep, 94. 
Roller skates, 90. 
Roof of the mouth, 44. 
Rubber cloth, 79. 
Rules for feeding, 136. 



S. 

Sago jelly, 172. 

Saliva, secretion of, 26. 

Salt-water bath, no. 

Scalds, 186. 

Scalp, swelling of, 179. 

Scarlet fever, 178. 

Second summer, dread of, 48. 

Secondary bleeding from the navel, 

180. 
Shirt, night, 79. 
Shoes, 74. 

bedroom, 79. 

knitted worsted, 69. 

the best fastenings for, 78. 
Short stockings, dangers of, 67. 
Sick room, disinfection of, 200. 
Skates, roller, dangers of, 90. 
Skin, general appearance of, 18. 



Skin, yellow staining of, 1 8 1. 
Sleep, 27, 91. 
Soap, Castile, 99. 

suppositories, 196. 
Soda bath, ill. 

Solution of lime, saccharated, 138. 
Sore nipples, 122. 

prevention of, 123. 
Sound milk, 154. 
Soup, clear brown, 168. 

oyster, 170. 
Spine, curvature of, 82. 
Sponge, 99. 
Sprains, 184. 
Starch gruel, 148. 
Stick for cleaning teeth, 112. 
Stimulants, 122. 
Stings of insects, 187. 
Stockings, 74. 
Stomach, capacity of, 136. 
Shippings, 143. 
Study, too much, 89. 
Substitutes for human milk, 130. 
Suck, manner of giving, 115. 
Sugar of milk, 137. 
Sulphur, 201. 
Swallowing, 29. 
Swelling of the breasts, 182. 
Swimming, 107. 
Syphilis, 27. 
Syringe for nutritive enemata, 177. 

hard rubber, 194. 



T. 

Table of the eruptive fevers, 198. 

showing increase in length, 21. 

showing increase in weight, 22. 

showing the development of 
children, 24. 
Tapioca, 17. 
Tea, 158. 
Tears, secretion of, 26. 

suppression of, 29. 
Teeth, care of, in. 

children born with, 47. 

milk, 45. 

permanent, order of eruption, 48. 

premature appearance of, 47. 

stick for cleaning, 112. 
Teething, increase of saliva in, 46. 



212 



INDEX. 



Teething, pauses in, 45. 
Temperature, manner of taking, 39. 

normal, 42. 
Thermometer, bath, 99. 

clinical, 39. 
Throat, examination of, 43. 

foreign bodies in the, 189. 
Toes, normal position of, 75. 
Toe nails, care of, 80. 
Tom-boys, 88. 
Tongue, the, 44. 

coated, 45. 
Tongue-tie, 183. 
Tooth brush, 112. 
Towels, bath, 100. 
Toys, 55. 
Treatment of fever, 199. 

fissure of the nipple, 123. 
Turkish towels, 105. 
Turpentine stupe, 205. 
Tyrotoxicon, 155. 



U. 

Ulceration of the navel, 180. 
Underclothing, woolen, 80. 
Urination, painful, 35. 
Urine, amount voided in 24 hours, 34. 

high colored, 35. 

incontinence of, 35. 

retention of, 1 81. 

smoky, 35. 

suppression of, 34. 
Uvula, the, 45. 



V. 

Veal broth, 169. 
Ventilation, 57. 
Ventilator board, 60. 

wheel, 59. 

window, 58. 
Vernix caseosa, 97. 
Vomiting, 32, 142. 



W. 



Walking, delay in, 23, 86. 
Walks, 87. 

Waste pipe, disinfection of, 61. 
Water, filtered, 158. 

importance of, 150. 

in the ears, 101. 

on the brain, 20. 
Weaning, 118. 

manner of, 1 19. 

premature, 121. 

sudden, 120. 
Weather, cold, 8x. 

damp and rainy, 84. 
Weight, table showing increase of, 22. 

yearly gain of, 23. 
Wet-nurse, 124. 

selection of, 125. 
Wetting the bed, 35. 



Y. 

Yawning, 37. 

Yellow staining of the skin, 



181. 



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